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Amid the coronavirus disease 2019 (COVID-19) crisis, the core functions of an acute care hospital are to continuously provide essential clinical care services to patients from community at large. The dual track healthcare system (DTHS) is a strategy for preventing the hospital infection and allocating the resources of an acute care hospital to treat COVID-19 patients while simultaneously providing indispensable clinical care services for non-COVID-19 patients. The key elements of DTHS include compartmentalizing the space within independent buildings, allocating buffer zones for patients who have not been confirmed for COVID-19 infection but require inpatient treatment, delegating manpower with appropriate support, establishing competent in-house laboratory that enables universal COVID-19 screening via reverse transcriptase polymerase chain reaction and employing real-time communication technology. The effectiveness of DTHS was confirmed through the results of questionnaire surveys of hospital patients and the research on the qualitative and quantitative changes in the provision of fundamental care services including both acute and continuous clinical care after the care for COVID-19 patients in the hospital. With a potential for subsequent explosive community infections, the pandemic public health crisis rendered by COVID-19 will be prolonged. Therefore, each acute care hospital should prepare its measures and strategies to mimic the DTHS for the maintenance of the hospital’s core functions in anticipation of a revisit of the situation

Recently, The Ministry of Health and Welfare(MOHW) introduced a new bill called the Law of Personal Care for the Elderly People(LPCEP). The bill has several important problems. First, the bill of LPCEP contains no comprehensive care but only personal care. Basically, the elderly would be in need of comprehensive care because they are weakened or in ill-health and must always be provided with medical treatment and personal care. However, MOHW has reduced the basic concept of services for the elderly from comprehensive care to personal care. Second, the design of the longterm care insurance scheme is distorted. Principles of insurance are not adopted making eligibility equal to the burden of insurance contribution. In addition, the burden of the nation is insufficient compared with that of Japan. Third, medical longterm care facilities(LTCF) are no longer provided for the elderly. It is inadequate for the elderly to be provided only non-medical LTCF. Fourth, in the beginning, the National Health Insurance Corporation would manage the LTC system, but in the long run, local government should manage it. Fifth, the assessment of eligibility scale is not estimated by professional medical man power. Half of the estimation committee is composed of public officers who have no professional knowledge or skills in simulative demonstration of long-term care insurance. Sixth, care management of core man power for LTC is not designed to adequately supply for the elderly. A personal caregiver only would be supplied. Therefore, the bill has to be put on hold. In case of a revision, the bill, which is designed inappropriately, should be reformed fully.
Aged ; Caregivers ; Humans ; Insurance ; Insurance, Long-Term Care* ; Japan ; Jurisprudence ; Local Government ; Long-Term Care* ; National Health Programs

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Carcinoma, Hepatocellular*

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Fever*

Amid the coronavirus disease 2019 era, concern about the safety of surgical teams related to surgical smoke (SS) is rising. As simple ventilation improvement methods (SVIMs), we replaced 4 of the 8 supply diffusers with a direction-adjustable louver-type, closed 2 of the 4 exhaust grills, and strengthened the sealing of the doorway. Dynamic changes in the concentration of particulate matter (PM) with sizes of < 1.0 μm (PM1.0) were measured using low-cost PM meters (LCPMs) at eight locations in the operating room (OR). SS concentration up to 4 minutes at the location of the surgeon, first assistant, and scrub nurse before and after SVIMs application decreased from 65.4, 38.2, 35.7 µg/m 3 to 9.5, 0.1 and 0.7 µg/m 3 respectively. A similar decrease was observed in the other 5 locations. SVIMs could effectively control SS and the LCPM was also effective in measuring SS in the OR or other spaces of the hospital.

Purpose: This study examined the clinical and radiological outcomes of TFNA (Trochanteric Fixation Nail-Advanced) and PFNA-II (Proximal Femoral Nail Antirotation-II) used in the treatment of unstable intertrochanteric femur fractures. The association between lateral screw sliding and lateral trochanteric pain was analyzed. Materials and Methods: The study included 116 patients diagnosed with unstable intertrochanteric femur fractures who underwent intramedullary nailing surgery at the author’s hospital. The patients were divided into two groups: 72 who received PFNA-II and 44 who received TFNA. Ten patients with positive greater trochanter tenderness and 106 patients with negative tenderness were assessed for the factors associated with lateral trochanteric pain. The radiological outcomes included an evaluation of fracture union, screw position, tipapex distance, proximal femoral nail protrusion, and lateral sliding length of the helical blade. The clinical outcomes were assessed using the Harris Hip Score, visual analogue scale (VAS) score, greater trochanter tenderness, and pre- and postoperative ambulation ability. Results: Thirty-three patients (45.8%) of the PFNA-II group and 18 (40.9%) of the TFNA group had lateral sliding of the helical blade, with no significant difference between the two groups (p=0.604). The VAS score was significantly higher in the TFNA group (3.77±1.71) than the PFNA-II group (3.10±1.57, p=0.032). Furthermore, the prevalence of a positive greater trochanter tenderness was significantly higher in the TFNA group (seven patients) than in the PFNA-II group (3 patients, p=0.04). Eight patients had lateral sliding in the positive greater trochanter tenderness group, whereas 43 had lateral sliding in the negative greater trochanter tenderness group (p=0.030). The lateral sliding length was 8.87±5.22 and 2.68±4.47 in the positive and negative groups, respectively (p<0.001). Conclusion The PFNA-II and TFNA groups showed favorable clinical and radiological outcomes, suggesting that both devices are suitable for treating unstable intertrochanteric femur fractures. A comparison of the two devices showed that TFNA induces more lateral trochanteric pain than PFNA-II, and the presence and extent of lateral sliding were associated with lateral trochanteric pain.