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Cerebral Stroke Onset Probability and Lifestyle in Individuals Who Underwent Medical Check-Up of the Brain at a Community Medical Support Hospital in southern Akita Prefecture

Hirohito NAMBU ; Susumu FUSHIMI

Journal of the Japanese Association of Rural Medicine.2016;65(4):747-757. doi:10.2185/jjrm.65.747

　　This study calculated risk scores associated with cerebral stroke onset by adding the scores of individual risk factors (sex, age, BMI, history of smoking, and presence or absence of diabetes and hypertension) in individuals who underwent medical check-up of the brain at a community medical support hospital, in order to obtain the supporting data for the promotion of primary preventive behaviors in individuals who underwent this specific medical check-up. Subjects were 1,426 individuals aged 40-60 years, comprising 798 men (56.0%) and 628 women (44.0%), who underwent medical check-up of the brain at the a community medical support hospital in southern Akita Prefecture between April 1, 2009 and August 30, 2013. Risk scores were not significantly different between men and women but were significantly higher in women with unruptured cerebral aneurysm than in women without (29.0±8.3 vs 22.00±8.9, p<0.001). Furthermore, scores of individual risk factors (age, BMI, history of smoking, diabetes, and blood pressure) were higher in individuals with unruptured aneurysm irrespective of sex (p<0.001). The findings of this study provide useful information demonstrating that obtaining risk scores in individuals who underwent medical check-up of the brain leads to better understanding of their lifestyle, the proportion of smokers, and the presence or absence of diabetes, obesity, and hypertension, all of which serve as a solid base in giving health instruction on the primary behaviors that prevent cerebral stroke.

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Current Situation of Children with Severe Physical and Mental Disabilities in the Rural Saku Region of Nagano Prefecture

Machiko HOSOYA ; Hideo USHIKU ; Tatsuya YODA ; Jumpei HASUMI ; Masahiko SAKAMOTO

Journal of the Japanese Association of Rural Medicine.2016;65(4):738-746. doi:10.2185/jjrm.65.738

　Recent advances in pediatric medicine have led to increasing numbers of severely disabled children who require medical care at home. Severely disabled children were defined as those who have or are at increased risk of having a chronic physical and developmental condition. On April 1, 2015, we conducted a survey of these children aged 18 years or younger living in the Saku region of Nagano Prefecture. Forty severely disabled children were identified in the Saku region, accounting for 0.02% of the population. Thirty children were being cared for at home and 10 had been institutionalized. The underlying illness or disorder occurred in the perinatal period in 21 children (52.5%). We further investigated the medical care and social support of those severely disabled children living at home. There were 8 children with an extremely severe disability and 7 with a moderately severe disability. Fifteen children did not fall into either category. One patient regularly received medical examination and care via visiting services and the remaining patients received outpatient care. Visiting nurses provided support and care for 10 children (33%), especially those who needed medical care, such as for tracheostomy and gastrostomy. Thirteen children (43.3%) used a short-stay service, and 19 children (63%) used outpatient support (after-school daycare service/day care service for holidays). Short-stay facilities and child day care services are lacking. The custody support system needs to be enhanced in this region for children and their family members to lead healthy lives.

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Trends Identified in Studies of Burnout among Visiting Nurses in Japan

Shigeko SHIBATA

Journal of the Japanese Association of Rural Medicine.2016;65(4):729-737. doi:10.2185/jjrm.65.729

　　This study investigated the factors identified to date in research related to burnout among visiting (home care) nurses and hospital nurses in efforts to help prevent burnout among visiting nurses. “Nursing”, “visiting nursing”, and “burnout” were used as keywords in a search of the Japan Medical Abstract Society database. Eight studies on visiting nursing were identified. The relevant factors for burnout among visiting nurses that have been identified so far are personal factors, work environment, human relations within the workplace and training systems, factors outside of the workplace, personal perceptions such as a sense of responsibility and burden which are thought to derive from these factors, and communication technology. Given these findings, to prevent burnout, it is important to establish a system that 1) enables nurses to work efficiently so that the physical burden from excess labor is lessened, 2) provides a work environment that reduces excessive burden and responsibility, and 3) recognizes nurses’ duties and growth and takes a positive approach to visiting nursing. It will be necessary to create more definitive preventive measures through further research based on the characteristics and difficulties of home nursing and a thorough understanding of the relationship between the relevant factors.

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Efforts to Reduce Inadequate Alarms in Ambulatory Monitoring of Electrocardiography

Koki HOTTA ; Maria NARITA ; Nodoka EBISHIMA ; Syoko ABE

Journal of the Japanese Association of Rural Medicine.2016;65(4):872-878. doi:10.2185/jjrm.65.872

　　We previously reported that only 49% of alarms in ambulatory electrocardiography (ECG) correctly indicated clinically abnormal electrical conditions in patients admitted to the cardiology ward and that 6 types of precautionary measures including changing the electrodes once a day and wiping sweat off the patient&rsqo;s chest skin might help to reduce false alarms. We sought to investigate the efficacy of these 6 types of measures to reduce false alarms in ambulatory ECG monitoring by comparing the number, variations, and causes of alarms before and after taking these measures. After taking these actions, the number of total alarms reduced from 3,699 to 1,109. The number of alarms indicating poor electrode-to-patient contact reduced from 629 to 30 and alarms indicating wrong diagnosis reduced from 432 to 114. However, the number of alarms indicating body movement of patients did not change (415 versus 418). Furthermore, we sought to investigate whether lowering the sensitivity of ambulatory ECG monitoring system to detect arrhythmia was useful for reducing the impact of inadequate alarms. We evaluated the incidence of missing true arrhythmias in the system and concluded that lowering the sensitivity was not a good option to reduce false alarms because of the increased risk of missing true arrhythmias.

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A Case of Spindle Cell Type Medullary Carcinoma of the Thyroid Diagnosed by Immunocytochemistry

Satoshi IKEDA ; Atsushi Uchida ; Kazunari INOUE ; Keiko SUZUKI

Journal of the Japanese Association of Rural Medicine.2016;65(4):868-871. doi:10.2185/jjrm.65.868

　　We report a case of spindle cell type medullary carcinoma of the thyroid in a 77-year-old man. Fine needle aspiration cytology showed numerous spindle cells without inflammation and hemorrhage. The spindle cells were uniform and exhibited no malignant features. Immunocytochemistry was positive for carcinoembryonic antigen and calcitonin, and the tumor was diagnosed as spindle cell type medullary carcinoma. There are various histological subtypes of medullary carcinoma, and diagnosis by cytomorphology alone is difficult. Preservation with LBC fixative was helpful for diagnosis by immunocytochemistry in this case.

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Effective Use of an Adrenaline Autoinjector in a Child Weighing Less than 15kg: A Case Report

Kiyotaka OHTANI ; Mayu FUJIMOTO ; Hitomi INAGAKI

Journal of the Japanese Association of Rural Medicine.2016;65(4):862-867. doi:10.2185/jjrm.65.862

　　The use of adrenaline autoinjectors is generally contraindicated in children weighing less than 15kg. However, their use may be beneficial in life-threatening situations. Here we report the case of a 2-year-old boy who weighed less than 15kg and had a history of 3 episodes of milk-induced anaphylaxis. He was prescribed an adrenaline autoinjector following parental consent. The boy experienced coughing, hives, dyspnea, hoarseness, and reduced consciousness after accidentally consuming dairy products during a family trip. His mother used the adrenaline autoinjector because the family was far from an emergency hospital. The patient’s condition was resolved and he was subsequently transported by ambulance to an emergency center and hospitalized. An antihistamine and a corticosteroid were administered to treat a persistent localized hives. No biphasic reaction was observed, and he was discharged the next day in good condition. An adrenaline autoinjector was effective for the emergency treatment of anaphylaxis in a child weighing less than 15kg. It is important to report such cases to accumulate and provide more information on the utility of adrenaline autoinjectors in children.

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A Case of Deep Venous Thrombosis and Pulmonary Thrombosis during Week 29 of Pregnancy

Sanae HATTORI ; Maiko ICHIKAWA ; Shiori OKIKURA ; Haruka MANAYAMA ; Kaori TAKAGI ; Yasuko NISHIDA ; Yukiko NUSHI ; Reiko NAKAMURA ; Tamami ODAI ; Seiichi ENDO ; Masae SAKAMOTO ; Koji SHIMABUKURO

Journal of the Japanese Association of Rural Medicine.2016;65(4):857-861. doi:10.2185/jjrm.65.857

　　A major cause of pulmonary thromboembolism (PTE) is deep venous thrombosis (DVT). We report here a case of DVT in a 31-year-old woman during week 29 of her second pregnancy. At week 29, the patient noticed swelling of the left leg and pain in the groin after sitting. At almost week 30, walking became difficult due to pain and she was referred to hospital. Computed tomography (CT) revealed a thrombus from the left common iliac vein to the femoral vein and multiple thrombi in the right pulmonary artery. Blood testing showed elevated D-dimer (3.4μg/ml). Continuous intravenous unfractionated heparin was administered, and the dose was increased due to decreased activated partial thromboplastin time control. Despite conservative therapy for DVT, the thrombi showed no change since admission. At almost week 37, a temporary inferior vena cava filter (t-IVCF) was placed to prevent pulmonary thromboembolism, and she had an uneventful delivery of a baby by Caesarean section. Warfarin was administered postpartum. The t-IVCF was removed 4 days after delivery, and the patient was discharged 10 days after delivery. Within the field of obstetrics, the need for IVCF insertion should be considered on an individual case basis and should not be viewed as a standard option.

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A New Technique for Extracting Ovarian Dermoid Cysts during Laparoscopic Surgery

Takanori YOSHIDA ; Tamami ODAI ; Koji SHIMABUKURO

Journal of the Japanese Association of Rural Medicine.2016;65(4):884-888. doi:10.2185/jjrm.65.884

　　Laparoscopic ovarian cystectomy is a relatively uncomplicated process, but extraction of the resected cyst can sometimes be difficult, especially with ovarian dermoid cysts. We report here our method of extraction for ovarian cysts measuring 7-10cm, where we trap the cyst laparoscopically and utilize the 12mm trocar of the umbilical port to extract the cyst externally.

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Consideration of a Survey Regarding Mortuary Care

Masao TANAKA ; Kyoko FUJIMURA ; Junko YAMADA

Journal of the Japanese Association of Rural Medicine.2016;65(4):879-883. doi:10.2185/jjrm.65.879

　　Our ward encounters many cases (approximately 80 every year) requiring end-of-life care. The experiences of nurses, as well as of patients’ families and friends, vary widely and nurses appear to be anxious about providing mortuary care, known as Angel care. There is no standardized manual, and therefore medical care professionals need to optimize good Angel care practices in order to alleviate nurses’ anxiety around the issue. We administered a questionnaire regarding the situation of Angel care to 208 ward nurses in our hospital and extracted difficulties in providing Angel care reported by the 173 respondents. Less than 5% of nurses, regardless of length of nursing experience, experienced no anxiety. Nurses found it difficult to conduct basic technical procedures: 51.7% had difficulties in closing the deceased patient’s mouth and 40.2% had difficulties judging whether the results of mortuary makeup resemble antemortem appearance. Ninety-five percent of nurses wished to study Angel care in the future should learning materials be available. In conclusion, more than half of nurses were anxious about providing Angel care regardless of length of their nursing experience and number of cases handled. Nurses are greatly interested in Angel care and wish to learn more if learning materials are made available.

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Perforation of the Diaphragm Caused by Percutaneous Trans-Gallbladder Drainage Catheterization in a Patient with Primary Sclerosing Cholangitis

Mitsuru OKUNO ; Seiji ADACHI ; Yohei HORIBE ; Tomohiko OHNO ; Naoe GOTO ; Noriaki NAKAMURA ; Osamu YAMAUCHI ; Koshiro SAITO

Journal of the Japanese Association of Rural Medicine.2016;65(4):850-856. doi:10.2185/jjrm.65.850

　　A 48-year-old man with jaundice was referred to our hospital. Endoscopic retrograde cholangiography showed primary sclerosing cholangitis. Endoscopic biliary drainage was not successful because of highly viscous bile, so we performed percutaneous trans-gallbladder drainage (PTGBD), which was able to reduce the total serum bilirubin level from 8 to 10mg/ml. Subsequently, an indwelling drainage catheter was placed in the gallbladder for 13 months. However, liver atrophy worsened with the gradual progression of hepatic failure. Twelve months later, he complained of dyspnea. Computed abdominal tomography showed that the drainage catheter had perforated the diaphragm and become exposed to the chest cavity. In spite of intensive care, the patient died of liver failure while waiting for a liver transplant. Careful attention should be paid to the possibility of this serious complication in such patients.

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