Journal Detail Information

1

Cite

Share

Relationship between Bilateral Fractures of Proximal Femur and Knee Osteoarthritis

Yuka YOKOYAMA ; Kohei OKI ; Toshiki KONDO ; Kotaro TAKASU ; Noriyuki NAKAMURA ; Yasutomo SUZUKI

Journal of the Japanese Association of Rural Medicine.2013;61(5):683-688. doi:10.2185/jjrm.61.683

  In recent years, the incidence of proximal femur fractures has been increasing with the aging of the population. There has been a growing number of those patients who injure on the other side of the hip at later date. We studied the relationship between proximal femurfractures and knee osteoarthritis, which is one of the diseases preceding fractures.
  We surveyed 234 and 17 patients hospitalized with unilateral and bilateral fractures, respectively at Atsumi Hoapital from April 2008 to March 2011. The research covered sex, age, the cause of injury, the period until they had proximal femur fractures on the other side, bilateral-fracture rate, incidence rates of diseases (cerebrovascular, eye and respiratory), knee osteoarthritis, dementia, diabetes and other forms of fracture.
  As a result, we confirmed the connection between knee osteoarthritis and bilateral fractures. There was every indication that knee osteoarthritis may be a major factor which leads to bilateral fractures. All patients with bilateral fracture injured resulting from falls.
  We believe it is important to take an approach on the treatment of hip fractures and prevention of knee osteoarthritis and falling.

2

Cite

Share

Current Nutritional Management for Home Care Patients

Hiroyuki KOSHIHARA ; Mayumi MIYAO ; Sawako YOKOTA ; Kikuo AIZAWA ; Shaw AKIZUKI

Journal of the Japanese Association of Rural Medicine.2013;61(5):689-694. doi:10.2185/jjrm.61.689

  The purpose of this study was to clarify the current nutritional management of patients receiving home-care services after discharge from Nagano Matsusiro General Hospital and to mull over the future nutritional management in their home.
  A questionnaire survey about nutrition was conducted on 53 home nursing care receivers and rehabilitation program participants.
  Patients with a body mass index of less than 18.5 (low BMI patients) accounted for 39.6%, and the total energy intake was predicted to be lower than necessary for these patients. Therefore, we deemed that it was necessary to calculate their nutritional requirements and evaluate their nutritional status.
  Nutritional evaluation was made in 84.9% of the patients. Weight was seldom measured, especialy among the enteral feeding groups.
  Not measuring weight is known to be related to an unfavorable outcome and hospitalization. Therefore, we thought it necessary to perform somatometry using a nutrition assessment kit, calculate nutritional requirements, and evaluate the nutritional status for risk reduction. Of the 44 patients who were taking food orally, 34.1% had dysphagia, and for 40% of them, there was no specific coping strategy.
  This indicated that dysphagia was not considered to be a major problem. A significantly large number of dysphagia cases were found among low BMI patients.
  For these patients, intervention by a speech therapist, as well as instruction about the risk of aspiration and choking, should be considered.
  There were significantly many a number of users of nutritional supplements among the low BMI patients, but 84.6% of them used products categorized as health foods. This suggested a lack of appropriate information about nutritional supplements. Accurate information should be provided to these patients.
  For nutritional management of home care patients, we concluded that intervention by multiple specialists (including dietitians, speech therapists, and dental hygienists) was necessary. The nutritional support team (NST) should intervene in cooperation with these specialists.

3

Cite

Share

Building Regional Dialysis Support System in Preparation for Massive Quake Disaster

Akihito YAJIMA ; Gen KURAMOCHI

Journal of the Japanese Association of Rural Medicine.2013;61(5):695-702. doi:10.2185/jjrm.61.695

A ground rule of dialysis support in the event of massive earthquake disaster is to perceive the necessity of evacuating patients quickly and to have a system fully equipped to collect information as to the situation of the designated disaster hospital in a region and other facilities and the capacity to take care of patients. Furthermore, building a network incorporating dialysis facilities in the neighboring areas is essential. Through this network, efforts have to be made to work out a practical dialysis support program without delay (annular support system). It is also important to create a support scheme which does not impose an excessively heavy burden on the staffs of damaged facilities. To put it concretely, the following measures should be taken:(1) to reduce the time needed for the transfer of patients to the mimimum;(2) to make the length of the patient's stay at a support facility the shortest possible;and (3) to get the data of dialysis patients ready and share the records with other dialysis facilities. To make the cooperative framework for tiding over a major earthquake disaster, it is important to establish the annular support system of dialysis facilities between the quake stricken area and its neighboring area. If a similar annular support system is not installed in many areas, cooperation does not function well. We must consider the ways and means to establish an ideal cooperative regional disaster prevention system in preparation of a large-scale earthquake, which may occur any time, while drawing a lesson from the previous earthquake disasters.

4

Cite

Share

Cooperation Between Hospital Pharmacy Department and Insurance Pharmacy in Outpatient Chemotherapy

Maki ITOH ; Kaori MIYATA ; Hirohide TAKAYA ; Atsushi SAITOH ; Shigeru TAKAHASHI

Journal of the Japanese Association of Rural Medicine.2013;61(5):703-709. doi:10.2185/jjrm.61.703

  Recently, the diversification of chemotherapy has brought about an increase in the number of outpatients who receive prescription drugs at insurance pharmacies after the intravenous infusion of anticancer agents at hospitals. The problem is that insurance pharmacies do not have ample knowledge of treatment plans and disease stages, and the presence or absence of cancer notification. Moreover, medication regimens, including washout, periods, have become so complicated that patient compliance rates have shown a tendency to decline gradually.
  Such being the circumstances, we have come to think that it would be better to enter into partnership with the dispensary of Senboku Kumiai General Hospital for sharing information in order to give the patients more beneficial medication instructions.
  For a start, we met with the hospital pharmacists, exchanged necessary information and ideas, got acquainted with chemotherapy regimens, and shared the tools of medication teaching. Through the participation in the guidance given by hospital pharmacists to outpatients who began to receive chemotherapy, and lectures on chemotherapy and medication by physicians and hospital pharmacists of the general hospital, we have become able to offer more appropriate counsel to the outpatients. Furthermore, we created a channel between the dispensary and Senboku Chozai Pharmacy for feedback and for asking questions about not only the conditions of the patients but also the presence or absence of cancer notification.
  We believe that our efforts have contributed toward increasing the safety and efficacy of chemotherapy.

5

Cite

Share

Problems With Medical Gas Fitting in Great Earthquake Disaster

Yasuji TAKANO ; Shuzo SHINTANI

Journal of the Japanese Association of Rural Medicine.2013;61(5):710-714. doi:10.2185/jjrm.61.710

The water supply system in our hospital was disabled as its elevated water tank was badly damaged by the earthquake that hit northeast Japan on March11, 2011. Subsequently, the dysfunction of suction equipment of a water seal type threw the whole hospital into utter confusion, though temporarily. We realized that injection of some degree of water could recover the suction system on manual. To minimize the damage from a natural disaster and strengthen the hospital ability for all contingencies, we have decided to employ the oil rotary type rather than the water seal type in the system of suction equipment.

6

Cite

Share

Physical Therapy of Parkinson's Disease Patient With Lateral Trunk Flexion due to Dystonia

Masaki HAKOMORI ; Taizo YAMAMOTO

Journal of the Japanese Association of Rural Medicine.2013;61(5):715-721. doi:10.2185/jjrm.61.715

The patient was a female in her 60's with Parkinson's disease. She had lateral trunk flexion, which was suspected to be caused by drug-induced dystonia with Pramipexole. Even one month after withdrawal of the drug, the condition didn't improve. Therefore, physical therapy was initiated. Chief complaints were pain of the left trapezius and erector spine, and inability to walk for a long time. Dystonia of oblique muscles caused lateral trunk flexion. Lateral trunk flexion caused the secondary pain of left trapezius and erector spine for compensation. Physical therapy using a sling was carried out to practice relaxation of the right oblique muscles and contraction of the right erector spine without conpensation of the left side. Standing position and gait training were done shoe height on the right side. After 7 months, pain of the left trapezius and erector spine dissapeared during rest and housework. Gait duration increased to over 1 hour. QOL (SF-36) was improved on all of 8 scores.

7

Cite

Share

A Case of Abdominal Wall Endometriosis After Cesarean Section

Daisaku HARAUCHI ; Kou UYAMA ; Yosiaki SHIMADA

Journal of the Japanese Association of Rural Medicine.2013;61(5):722-725. doi:10.2185/jjrm.61.722

A 39-year-old woman was admitted to our hospital because a hard mass about 3cm in diameter with a tender was found in a scar of cesarean section. Ultrasonography (US) showed a 22.9×14.9×24.5 mm hypoechoic and heterogeneous mass with an irregular margin. Abdominal contrast-enhanced CT scan showed an enhanced mass in the abdominal wall. The US-guided needle biopsy of the mass was performed for the histological diagnosis and the mass turned out to be endometriosis that was positive staining for vimentin, estrogen receptor and CD10 by immunohistochemistory. Measures available for the treatment of endometriosis are hormone therapy and surgical resection. In our case, surgical resection was performed completely, because preoperative diagnosis of the disease was made from a needle biopsy. It is important to avoid extended operation and to employ appropriate therapies combined with hormone and surgical therapy to maintain the patient's quality of life, because endometriosis is a benign disease per se.

8

Cite

Share

Prevention of Falls Among Inpatients

Sayuri SATO ; Kyouko ITO ; Akiko KOSHIDAKA ; Miwa KOBAYASI ; Mayumi SATO ; Yukari ASANO ; Hiroko MORIYAMA ; Kana OTA

Journal of the Japanese Association of Rural Medicine.2013;61(5):726-731. doi:10.2185/jjrm.61.726

  Specific activities of the working group include reviewing the assessment score sheet of all falls and the preventive measures by degree of risk, making staff education, training, monitoring the implementation of the safety and preventive recommendations for prevention of falls.
  The data of all inpatient falls which occurred during one year prior to and one year subsequent to the WG intervention were analyzed.
  The incidence of inpatient secondary falls, decreased from 155 to 108 , and reports of level III severe falls, showed a reduction from five cases to three. Statistically, the total percentage of secondary falls incidence decreased from 2.19‰ to 1.54‰.
  We therefore concluded that through the activities of the WG, the strengthening of the in-house system to prevent secondary falls, staff education, training, and heightened staff safety awareness have led to a decrease in the total number of primary and secondary inpatient falls.

9

Cite

Share

Behavior of Nurses and Full-Time Risk Managers Following a Medical Mishap:

Yuko SHINTAKU

Journal of the Japanese Association of Rural Medicine.2013;61(5):732-740. doi:10.2185/jjrm.61.732

About nine years have passed since full-time risk managers (RMs) were installed for the first time in Japanese hospitals. RMs foster safe practices within the hospital in compliance with orders from hospital administrators. The current study of nurses/full-time RMs in hospitals with 250 or more beds and additional medical safety measures focused on how RMs would interact with the nurses who committed errors, ward heads, and ward staff in the event of a level 3a medication error as of September 1, 2009. Results; 60% of 249 RMs who responded to the survey asking whether they would (1) collect information, (2) analyze the mishap's cause, (3) identify problems, (4) formulate measures to prevent the mishap from occurring again, (5) obtain feedback, (6) implement improvements, and (7) participate in all steps of assessment. About 50% of RMs said they would “collect information” in concert with the nurses in question and act with ward heads in all steps. More than 60% of RMs said they would give advice and more than 50% said they would make requests to ward heads.

10

Cite

Share

Caring for Patients to Enable Them to Live Better and Longer

Yumiko MATSUTANI ; Ichie ONO ; Keiko KATO

Journal of the Japanese Association of Rural Medicine.2013;61(5):741-745. doi:10.2185/jjrm.61.741

Our hospital is the only general hospital in Akitakata City, Hiroshima Prefecture. It plays an important role as a core hospital in enhanceing the quality of medical care, welfare, and health care in this region. With the advent of the super-aging society, the needs of aged patients are complicated and diverse. Accordingly, the problems and needs of patients have become difficult to cope with by medical treatment alone. To cope with the current situation, in April 2010, we established the Department of Outpatient Nursing Care, which is managed by nurses certified as palliative care and dementia care specialists, aiming to support medical treatment and lives for patients. The Department of Outpatient Palliative Care specializes in caring for patients with diseases such as cancer as well as their families, and the Department of Outpatient Memory Care specializes in caring for dementia patients and their families. These departments intend to provide not only medical treatment to people in our community but also support patients so as to enable them to spend the rest of their lives in peace. Here, we report our nursing care activities.

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share