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What Makes Long-Term Home Care Possible for People with Senile Dementia

Shinji MIYAHARA ; Sachie YAMASHITA ; Takako TSUKAHARA

Journal of the Japanese Association of Rural Medicine.2011;60(4):507-515. doi:10.2185/jjrm.60.507

This study was designed to explore what would make it possible for old people with moderately severe dementia to receive health care in their homes. For this purpose, a questionnaire survey was conducted on the cases of patients who had been given home care services for more than six months. A total of 97 cases (31 males and 66 female) were enrolled in this multilateral study. Of the total, 60 cases were admitted to facilities six months after the start of home care. As it turned out, the degree of cognitive decline was severer in those who had continued receiving home care than in those institutionalized. Ardent physicians and zealous care managers played a crucial role in sustaining home care services. Also indispensable were able, hardworking caregivers with profound knowledge of nursing care. The availability of nursing care insurance services, especially day services, short stay and regular visits by a physician and a nurse to patients in their homes might be necessary. Given all these things combined, it would be possible for people with moderately severe dementia to receive long-term home care services.

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Use of Geographic Information System to Measure Access to Health Care Facilities in Rural Communities in Mountainous Region

Tsuyoshi HAMANO ; Yoshinari KIMURA ; Miwako TAKEDA ; Masayuki YAMASAKI ; Kuninori SHIWAKU

Journal of the Japanese Association of Rural Medicine.2011;60(4):516-526. doi:10.2185/jjrm.60.516

As is often the case with rural communities in Japan, a dearth of health resources poses a serious problem in a mountainous region of Shimane Prefecture. Although a medical care plan focusing on needs of people should be devised with a view to building up a sustainable health care system, studies have not always adequately been pursued. The aim of this study was to assess the data on the patients with lifestyle-related health problems to and from health care facilities. A Geographic Information System was used for measuring the travel time and road distance. The data for 255 patients with hypertension, 114 patients with hyperlipidemia, and 42 patients with diabetes were amassed. The results showed that the average travel time and distance were much longer in patients with diabetes than those with hypertension. Statistically no significant difference was observed in severity of diabetes (HbA1c, BMI and LDL-c) and blood pressure levels between patients who received regular treatment at clinics in the two towns and those who went all the way to clinics outside of the towns. In addition, compared with the patients with diabetes aged 75 years or over, the average travel time and road distance for aged of 74 years or younger were much longer. Similarly, compared with the patients with hypertension aged 75 years or over, the average travel time and road distance for aged of 74 yeras or younger were also much longer. These results indicated that the diabetics and the elderly age 74 or younger tended to go to health facilities beyond the secondary-medical care zone. These findings also suggested that a closer cooperation between facilities in the neighboring secondary-medical care zones to improve the quality of medical services and support general practitioners to review the existing disease management program would make it possible to cope with the present situation.

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Clinical Features and Treatment Outcome of Childhood Leukemia

Yuji MIYAJIMA ; Erika KITAMURA ; Yoko SHIBATA ; Chihiro HATANO ; Fumiko MIYAZAKI ; Sachie ITO ; Jun SAWAI ; Miyuki MAGOTA ; Kaname MATSUSAWA ; Tatsuya FUKAZAWA ; Koji TAKEMOTO ; Tetsuo KUBOTA ; Yuichi KATO ; Akimasa OGAWA ; Kuniyoshi KUNO

Journal of the Japanese Association of Rural Medicine.2011;60(4):527-534. doi:10.2185/jjrm.60.527

We reviewed the clinical features and treatment outcome of 110 children with leukemia. Treatment was performed between 1980 and 2009 at our hospital. The mean age at onest was 5 years 6 months, the ratio of males to females was 1:0.72, and mean leukocyte count was 4.91×10⁴/μl. Subtypes of leukemia were acute lymphoblastic leukemia (ALL) in 79.1% of the patients, acute myeloid leukemia (AML) in 17.2%, and chronic leukemia in 3.6%. In all patients, the overall 30-year survival rate estimated by the Kaplan-Meier method was 67.4%. In the three decades from the 1980s, the overall 10-year survival rate has been improved significantly from 46.4% in the 1980s, 69.2% in the 1990s to 87.2% in the 2000s (P<0.01). The overall 10-year survival rate was 70.7% in all children with ALL, and 70.6% in all children with AML. But in the last decade, the 10-year survival rate was improved to 87.0% in children with ALL and 87.3% in children with AML. Twenty-four patients received hematopoietic stem-cell transplantation, and the 10-year survival rate was 58.6% after transplant. Second malignancies were detected in three patients, and six patients have long-term sequelae. In conclusionn, the treatment result of childhood leukemia has improved considerably, so that more intensive treatment for patients with poor prognosis and less toxic treatment for patients with good prognosis will be necessary in future.

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Changes in Mood Resulting from Portrait Therapy From an experiment involving with new nursing staff members and others in a palliative care ward

Hideyuki KAWAIDE ; Naohito YAMAMOTO ; Youhei OOHASHI ; Miki HIBINO

Journal of the Japanese Association of Rural Medicine.2011;60(4):535-542. doi:10.2185/jjrm.60.535

The POMS (Profile of Mood States) was used to investigate changes in mood and affect that appeared after the Portrait therapy, a method conceived and initiated by Kenichi Muraoka in 2006. The subjects consisted of 46 new nurses (1 male, 45 females, average age 23.09 years); 1 patient hospitalized in the palliative care ward (1 male in his 80s) and 1 family member attending therapy sessions (1 female in her 60s); 3 ward nurses (1 male, 2 females, average age 38.67 years); 3 students participating in hands-on training (3 females, average age 21.67 years);and an additional 3 staff members (3 males, average age 40.67 years). The POMS was administered before and after the Portrait therapy, and the changes in POMS score were examined. The new nurses showed a significant improvement in mood across all 6 subscales of the POMS. There was a general improvement in mood among the participants from the palliative care ward, exeluding the nurses. The Portrait therapy proved to be an effective means of improving the mood of participants, and bystanders as well, depending on their position. While due care is needed before implementing the Portrait therapy in a hospital ward, this therapy is a viable emotional care alternative, and is also potentially meaningful in the context of grief care. In the future, we intend to follow up with case studies and quantitative studies to find more effective Portrait therapy applications.

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Two Cases of Traumatic Ulcer on Penile Shaft

Hiroyuki TAKAHASHI

Journal of the Japanese Association of Rural Medicine.2011;60(4):543-547. doi:10.2185/jjrm.60.543

The author reported 2 cases of traumatic ulcer on penis. One case showed a remarkable necrosis and infection on penis after the patient was kicked in the crotch during a fight. The other case revealed a massive necrosis of penile skin associated with purpuric change of scrotal skin after excessive exercise. Conservative treatment failed to improve the skin ulcer of both patients, therefore we carried out a debridment and mesh skin graft. Mesh skin grafts, instead of sheet skin grafts, were used. They proved to be applicable to the genital area, particularly to the penis without any post-operative functional troubles including difficulty in passing urine.

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Consideration of Problems Attendant on Trace Element Deficiency

Shinji OKUMOTO ; Yuko KANAMEDA ; Tomoki KITAMURA ; Masakazu CHIKAMORI ; Norio NAKANISHI

Journal of the Japanese Association of Rural Medicine.2011;60(4):548-554. doi:10.2185/jjrm.60.548

Various kinds metals are present in varying concentrations in living bodies. They play important roles in the preservation of life functions. Owing to the recent advances in multidisciplinary research on biochemical and nutritional functions of trace elements, their deficiency and excess, etc., close attention is being paid to the importance of trace elements. During nutritional therapy, it is important to check for shortage of trace elements as nutritional indicators. It is known that prolonged nutritional therapy is associated with the risk of developing trace element deficiency. We recently encountered patients suspected of having trace element deficiency. For a case of selenium deficiency, we added a selenium solution (homemade parental solution) to the solution for intravenous hyperalimentation. For a case of zinc deficiency accompanied by pressure ulcer, polaprezinc (a zinc-containing preparation for the treatment of gastric ulcers) was used. In both the cases, the serum trace element level improved, and the outcome was favorable. Adequate precautions need to be exercised when the methods of medication, test, etc., are decided upon in the cases of trace element deficiency. Herein, we also discuss problems associated with tests and treatment of patients with trace element deficiency.

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Considering the Utilization of “Discharge Support Protocol” on Acute Care Ward

Mari YOSHIDA ; Junko YAMAMOTO ; Misako KOUNOSU

Journal of the Japanese Association of Rural Medicine.2011;60(4):555-561. doi:10.2185/jjrm.60.555

In our hospital, we have appointed some nurses to full time support and adjust patient discharges since May 2009. We have an electronic “Discharge Support Protocol”, which is a tool that includes discharge adjustment screening, discharge support assessment, discharge adjustment planning, and discharge support planning. However, only a few ward nurses have used the tool. We performed a survey of nurses in the acute care ward, where 32% of the inpatients require discharge support input to consider how the “Discharge Support Protocol” could be fully utilized. The main reasons given for the low input rate were the difficulty in finding time from routine ward duties, and the vagueness of the protocol. We, therefore, made it part of the routine ward duty to fill out the discharge support protocol, and also made the work flow clearer. As a result, we found an increase in input rate of the first part of the protocol which deals with discharge adjustment screening, but did not find any change in input rate from the second part onwards. The challenge from now on will be to take further measures to improve the overall input rate. In addition, we have suggested the usability of the “Discharge Support Protocol” to educate ward nurses, and to share information about patients between nurses and other departments.

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164 Patients with Hymenoptera Stings Treated at Chita Kousei Hospital

Atsuko ONO ; Noriyuki SAKAKIBARA

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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