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164 Patients with Hymenoptera Stings Treated at Chita Kousei Hospital

Journal of the Japanese Association of Rural Medicine.2009;58(1):21-25. doi:10.2185/jjrm.58.21

A total of 164 cases with Hymenoptera stings have been treated in our hospital during the 3 year period from 2002 to 2004. We examined year-on-year incidence of the insect stings, monthly distribution, occurrence time, elapsed time from occurrence to visit to our hospital, age, male-female ratio, stung parts, number of stings, types of Hymenoptera, symptoms, and the rate of emergency room visits. The largest number of 83 cases were treated during 2004. A great number of cases were observed from June to September. The stings most frequently occurred during the daytime, and 95 males (58%) and 69 females (42%) were treated. Many of them were in their 50s years or above. The parts which the insect attack were mostly exposed parts such as hands, the upper limbs, face, and legs. Seven cases had systemic reactions (4%), one had urticaria, one had palpitations, two had nausea, two felt ill, and one suffered a anaphylactic shock. The most of the victims were elderly people engaged in agriculture in this area. The stings were most frequently observed in 2004, because there was less precipitation from May to June in that year. The propagation of Hymenoptera became active when the rainfall decreased.
Hymenoptera ; Hospitals ; seconds ; occurrence ; Sting Injury

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Quality of Medicine and Diagnosis Procedure Combination (DPC) Payment System: A Survey

Eiichi YABATA ; Hisao TAMAKI

Journal of the Japanese Association of Rural Medicine.2009;58(1):26-33. doi:10.2185/jjrm.58.26

DPC is the diagnosis dominant classification defined by diagnosis and procedures. The comprehensive daily payment system by DPC is being implemented in 731 hospitals across Japan. Of the hospitals affiliated with the Japanese Federation of Agricultural Cooperatives for Health and Welfare, 24 hospitals introduced this system in 2008. In September 2008 we mailed a questionnaire to them, and 23 hospitals responded. The mean of the comprehensive pay amounted to 105% of the piece rate. The average length of hospital stay shortened from 15.7 to 14.2 days. The bed occupancy rate decreased from 86.5 to 81.4%. For the preservation of the bed usage, most of the respondents said it was essential to keep in contact with neighboring hospitals and clinics. The adaptation rate of clinical pathways was only 29%. The proportion of generic drugs was 5.9%. In the DPC payment system it is necessary to maintain both the quality of medicine and the cost-effectiveness.
Medicine ; payment ; System ; Diagnostic ; With quality

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Improved Database Management System for Surveillance of Drug-Resistant Microorganisms

Akira HIRAISHI ; Hironori IWANO ; Kazuyo SATO ; Takeshi MATSUMURA ; Tadashi KOISHIZAWA

Journal of the Japanese Association of Rural Medicine.2009;58(1):34-38. doi:10.2185/jjrm.58.34

In step with the widespread use of antimicrobial agents in medical treatment, microbial substitution and emergence of new drug-resistant bacteria have become life-threatening problem today. Both have resulted from the postopreative practice of administering prophylactic medication and long-term, desultory drug administration. Drug-resistant microbes can occur easily with the inadequate use of drug. Therefore, our hospital has held in check the incidence of drug-resistant microbial infection by letting ICT members make the rounds of the wards and go over the notifications of the prescription of specific antimicrobial agents and the reports on drug-resistant bacteria. At the begiing, the notification and the report were filed separately. Recently, the information obtained from thses two channels has become easier of access because all the necessary data appear on the same screen at once by using patients' IDs. We believe that the streamlining of work and putting two kinds of data together have proved very usefull for infection control, as it has become possible to keep careful watch over the use of specific antimicrobial agents and the detection of drug-resistant microorganism simulataneously. By sharing the information obtained by us with all the rest on the hospital staff, we will continue to make efforts along this line and contribute toward the prevention of the outbreak of nosocomial infections as well as community-acquired ones.
Microorganism ; Pharmaceutical Preparations ; Medical Surveillance ; microbial ; Bacterial

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Clinical Support of Laboratory As a Culture room in In-Vitro Fertilization Program

Toshio SHIMIZU ; Jun KANEMOTO ; Kyoichi MIYAGAWA ; Akira TAKEDA ; Sayaka CHIGA ; Hiroko SAKON ; Kiyoshi KATO ; Takaaki HONDO ; Kaoru KIMURA

Journal of the Japanese Association of Rural Medicine.2009;58(1):39-45. doi:10.2185/jjrm.58.39

Taking charge of in-vitro fertilization and embryo transfer in the laboratory per se amounts to a form of clinical support. To infertile patients, it would be of great benefit if laboratory technicians make direct contact with them and give a full account of the procedure.The apprehensions entertained by them regarding infertility treatment would be removed by hearing what they want to know.In hopes of dispelling the patients' fears and doubts, we have recently started to dialogue with the patients. The face-to-face interview has made us feel confident in what we are doing aside from the lab work and feel a sense of responsibility. Moreover, we have become aware of the need to further devote ourselves to reproductive medicine in order to improve the treatment outcome.One third of the questions frequently asked by patients concerns the quality of embryos and the risk of birth defects, which are issues that challenge us involved in reproductive medicine. To give answers to these and other questions most aptly, it is necessary to share all the up-to-date information, data and knowledge among members of the staff concerned.As the tasks to be grappled with fromnow on, there are problems with unsuccessful cases after repeated IVF trials and an increasing number of patients rangingin age from 45 to 49 years. Where the infertility treatment stops is yet to bedecided in the case of elder women.For providing information and psychological support sought by patients, we keenly felt that there is a necessity to establish a closer collaborative inter-departmental relationship.
Clinical ; Fertilization ; Laboratory culture ; Support ; therapeutic aspects

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Effectiveness of Sanitary Education with the ATP Wipe Test and Scrubbing Checker

Chinatsu YAMADA ; Tetsuaki SHUMIYA ; Saori FUKAMI ; Takao OZAKI

Journal of the Japanese Association of Rural Medicine.2009;58(1):46-49. doi:10.2185/jjrm.58.46

Proper hand scrubbing is very important for the prevention of food poisoning. The scrubbing checker is a method for determining the level of cleanliness based on light emitted from the hands after washing with a lotion containing fluorescence. In March 2008, we examined the hands of 33 individuals on the staff of the Department of Dietetics, Konan Kosei Hospital, using the ATP wipe test and the scrubbing checker. We also investigated the effectiveness of sanitary education using both methods. The ATP wipe test was conducted twice. The first test was done after normal scrubbing, and scrubbing education was given later. In order to evaluate the effectiveness of sanitary education, the second test was done approximately one week after the first test and the ATP levels obtained before and after sanitary education were compared. The measurements were evaluated in three stages:grade A (satisfactory), B (borderline) and C (unsatisfactory). For sanitary education, hand cleanliness was confirmed by each of the participants themselves using the scrubbing checker. In the first test, 58% of those tested were evaluated as grade A. Sanitary education using the scrubbing checker showed that scrubbing of the nails was inadequate in 64% of the examinees. Therefore, education was given about scrubbing the nails against the palm of the other hand. In the second test after scrubbing education, the percentage of those evaluated as gradeA increased to 91%. As a result of these findings, it was concluded that sanitary education using the ATP wipe test and the scrubbing checker is effective. We plan to prevent food poisoning by conducting both tests periodically hereafter.
educational ; Azathioprine ; Hand ; Grade ; Educational Background

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On the Appellations of Our Discipline and Association

Hirohiko YAMASE

Journal of the Japanese Association of Rural Medicine.2009;58(2):51-53. doi:10.2185/jjrm.58.51

Discipline ; Mental association

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Nutritional Status in Hemodialysis Patients - Changes in Biochemical Parameters and Clinical Symptoms

Emiko TSUCHIDA ; Maiko SATOH ; Gen KURAMOCHI

Journal of the Japanese Association of Rural Medicine.2009;58(2):54-62. doi:10.2185/jjrm.58.54

A strong earthquake (magnitude 6.8) off the Sea of Japan struck the Chuetsu area of Niigata Prefecture on July 16, 2007. By way of investigating the impact of the earthquake on the health of maintenance hemodialysis patients, we examined several biochemical parameters including nutritional markers and psychological stress markers and checked up on the incidence of earthquake-induced complications (heart failure and shunt obstruction). Blood samples were collected and the values of several biochemical parameters were measured. Incidences of clinical complications one, three and six months after the quake were scrutinized. Significant decreases in the nutritional markers and a significant increase in the incidence of complications were found one month after the quake. During this period, the supplies of electricity, city gas and water were completely recovered one after another. The significant changes in the nutritional levels and the incidence of complications coincided with the time of the complete recovery of these utilities. The levels of these parameters recovered and the incidence of complications reduced three months after the quake. However, the serum albumin level did not recover and remained significantly lower even six months after. The psychological stress markers increased significantly three months after. These suggested that there was the time lag between the decrease in the nutritional markers, the increase in the incidence of complications (1 month after earthquake) and the increases in the psychological stress markers (3 months after earthquake). We concluded that these findings provided important information for the total medical plan to maintain the physical and psychological states of hemodialysis patients in an earthquake- stricken district.
month ; Complications Specific to Antepartum or Postpartum ; Earthquakes ; incidence of cases ; Hemodialysis

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The Incidence of Thyroid Dysfunction in the Adult Health Examinees in Kutchan Kosei General Hospital

Kimio KAWASAKI ; Mutsuo BENIKO ; Yasuo MASHIO

Journal of the Japanese Association of Rural Medicine.2009;58(2):63-67. doi:10.2185/jjrm.58.63

We studied the thyroid dysfunction occurrence in the adult people who went through health examinations in Kutchan Kosei General Hospital between April 2, 2007 and March 31, 2008.Enrolled in this study were 1,647 adult men and 1,104 adult women. However, 17 men and 51 women were excluded from the study because they had histories of thyroid diseases.Serum FT3 and FT4 values were lower in women than in men. Likewise, serum TSH values for women were higher than those for men.Hypothyroidism (low serum FT3 and FT4 levels) occurred more frequently in women than in men. More women than men showed serum TSH values over 49.1μU/ml.
Human Females ; Male population group ; Adult ; Serum ; Desiccated thyroid

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Exposure Conditions in Measurement of Visceral Adipose Tissue by CT

Taku FUDEYA ; Yoshitake ITO ; Akitoshi YOSHIKAWA ; Shoichiro OTAKE

Journal of the Japanese Association of Rural Medicine.2009;58(2):68-72. doi:10.2185/jjrm.58.68

[Purposes] In 2005, criteria for diagnosing the metabolic syndrome was officially announced. Accumulation of fat tissue in and around the abdomen is one of the metabolic syndrome. To assess the excess fat tissue, the waist circumference is measured. Computed tomography can work out the area of the intra-abdominal fat tissue. In this study, we examined exposure conditions with a view to reducing dose and radiation risk.[Methods] A CT phantom model simulating the abdominal area at the level of the umbilicus was made for obtaining the pictures of the intra-abdominal fat tissue with the tube current ranging from 10 mA to 250 mA set at intervals of 10 mA. The average CT value for the area of mimic fat tissue obtained by each scan and standard deviations were worked out.[Results] The size of fat tissue and the mean CT value were constant with a tube current of 100 mA or over. [Conclusions] It was found possible to measure the area of intra-abdominal fat tissue with a tube current of 100 mA. Therefore, our findings showed that the radiation exposure could be reduced by 60% when compared with the 250 mA CT used at a clinical setting.
Adipose tissue ; X-Ray Computed Tomography ; mA ; Radiation ; Accident due to exposure to weather conditions

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Results of Thyroid Gland Examinations by Ultrasonography Conducted as Part of the Cerebraovascular Disease Screening Program

Tsuyoshi OGIHARA ; Shingo UEHARA ; Hiroko SASAKI ; Shigetada KIKUCHI ; Aiko SATOU ; Masaru TAKAMIZAWA ; Haruko IDE ; Miwako NAKATA ; Toshio HATAKEYAMA

Journal of the Japanese Association of Rural Medicine.2009;58(2):73-78. doi:10.2185/jjrm.58.73

Participants in our screening program for cerebrovascular disease are supposed to receive thyroid checkups at the time of ultrasound imaging of carotid arteries. Thus far, a total of 4,338 people have participated in this program. Of the total, 17 cases of papillary thyroid carcinoma were found (detection ratio: 0.39%). This study concerned with the 13 cases which underwent surgical treatment in our hospital. They all were diagnosed as early cancers--eight cases at stage N0 and five cases at stage N1--with an average tumor diameter of 11 mm. Besides, five cases of Basedow's disease (hyperthyroidism) and 15 cases of chronic thyroiditis were found (detection ratio: 0.35%). Of the 15 chronic thyroiditis cases, nine were found to have symptoms of hypothyroidism. We concluded that our screening program for cerebrovascular disease involving the ultrasonographic scans of the thyroid gland is very helpful not only in detecting malignancies at an early stage but also in screening for functional abnormalities of the thyroid.
Aspects of disease screening ; Ultrasonography ; Desiccated thyroid ; Thyroid Gland ; Diagnostic Neoplasm Staging

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