Even within a hospital, the prognosis after a cardiac arrest is extremely poor if intervention starts only after the event; thus, early recognition and intervention is crucial to reduce inhospital cardiac arrests. This paper aims to assess the results of in-clinic surveys conducted for the implementation of the Rapid Response System (RRS) at our hospital and changes in awareness after awareness initiatives. Excluding the neonatal intensive care unit, all wards were targeted for implementation, with the creation of criteria for requesting the RRS and hospital-wide awareness initiatives. Four items were defined for the request criteria—namely, (1) respiration, (2) circulation, (3) state of consciousness, and (4) others (any concerns)—with a request being warranted if any one of these criteria was met. A pre-awareness survey revealed that respiratory rates were recorded only 6.9% of the time on average, indicating inadequate observation of respiratory rates across all wards. In response to this issue, we announced that respiratory status should be observed at least once a day, which resulted in the recording rate improving to 68.2% after 2 months. Survey results before and after the awareness initiatives among doctors and nurses showed a significant increase in RRS awareness. The percentage of nurses who answered “well aware” or “somewhat aware” increased from 34.8% to 77.6%, and from 63.4% to 88.0% among doctors. However, while the introduction of the RRS was relatively well-received by nurses struggling with on-site responses, some doctors questioned the necessity of the RRS. Upon implementation, it is important to make it known that it is a hospital-wide effort. Simplifying and thoroughly utilizing the request criteria can lead to early recognition of abnormalities. Since it is not easy to gain doctors’ understanding, it is necessary to listen to the needs and requests of each department and patiently continue awareness activities before implementation

The aim of this article is to describe the 2017 revised consensus criteria for the clinical diagnosis of dementia with Lewy bodies (DLB) with future directions for the diagnostic criteria. The criteria for the clinical diagnosis of probable and possible DLB were first published as the first consensus report in 1996 and were revised in the third consensus report in 2005. After discussion at the International DLB Conference in Fort Lauderdale, Florida, USA, in 2015, the International DLB Consortium published the fourth consensus report including the revised consensus criteria in 2017. The 2017 revised criteria clearly distinguish between clinical features and diagnostic biomarkers. Significant new information about previously reported aspects of DLB has been incorporated, with increased diagnostic weighting given to rapid eye movement (REM) sleep behavior disorder (RBD) and iodine-123-metaiodobenzylguanidine (MIBG) myocardial scintigraphy. Future directions include the development of the criteria for early diagnosis (prodromal DLB) and the establishment of new biomarkers that directly indicate Lewy-related pathology, including α-synuclein imaging, biopsies of peripheral tissues (skin, etc.) for the demonstration of α-synuclein deposition, and biochemical markers (cerebrospinal fluid/blood), as well as the pathological evaluation of the sensitivity and specificity of the 2017 revised diagnostic criteria. In conclusion, the revised consensus criteria for the clinical diagnosis of DLB were reported with the incorporation of new information about DLB in 2017. Future directions include the development of the criteria for early diagnosis and the establishment of biomarkers directly indicative of Lewy-related pathology.

No abstract available.
Cost-Benefit Analysis ; Rituximab ; Waldenstrom Macroglobulinemia

No abstract available.
Lymphoma

BACKGROUND: Waldenström Macroglobulinemia (WM) is a rare subtype of indolent B-cell lymphoma, and prospective randomized studies on WM are scarce. The R-CHOP therapy [rituximab (R), cyclophosphamide, hydroxy-doxorubicin, vincristine, and prednisone] is a popular and recommended regimen for primary therapy, prescribed by several treatment guidelines for WM. However, treatment with R-CHOP is accompanied by severe myelosuppression and high rates of peripheral neuropathy. Therefore, we retrospectively evaluated the efficacy and toxicity of half-dose CHOP combined with R as a primary therapy for WM. METHODS: Patients with untreated symptomatic WM, treated at the Disaster Medical Center between April 2011 and September 2016, were retrospectively analyzed after administration of 6 cycles of half-dose R-CHOP for every 3 weeks. The response, median time to response, best response, progression-free survival, overall survival, and toxicities were evaluated. RESULTS: Of the 20 WM patients analyzed, 16 (80%) received half-dose R-CHOP without vincristine, and 13 (65%) responded to the treatment. With a median follow-up duration of 26.3 months, the 2-year progression-free survival and 2-year overall survival rates were 70 and 93.3%, respectively. The median time to response and best response were 6 and 9.9 weeks, respectively. Grade 3/4 leukocytopenia, neutropenia, febrile neutropenia, and Grade 1 peripheral neuropathy developed in 32, 37, 0, and 21% of patients, respectively. CONCLUSION: The half-dose R-CHOP is an effective and well-tolerated primary therapy for WM. To the best of our knowledge, this is the first study reporting the use of a reduced-dose R-CHOP regimen for the primary treatment of WM.
Cyclophosphamide ; Disasters ; Disease-Free Survival ; Febrile Neutropenia ; Follow-Up Studies ; Humans ; Leukopenia ; Lymphoma, B-Cell ; Neutropenia ; Peripheral Nervous System Diseases ; Prospective Studies ; Retrospective Studies ; Rituximab* ; Survival Rate ; Vincristine ; Waldenstrom Macroglobulinemia*

　　This study was designed to clarify the factors affecting hospital staff behavior toward participation in lectures and workshops held in our hospital. A questionnaire survey was conducted to evaluate staff background and staff participation in these events. The survey revealed that in the past year, 78.7% of staff had attended lectures or workshops at least once. The participation rate in lectures and workshops associated with medical safety and infection control was 50.4% and 38.4%, respectively. Additionally, the participation rate was dependent on job type. Of interest, staff behavior toward participation was strongly influenced by factors related to the training content, such as medical safety and infection control, but not by environmental factors, such as marital status and familial status (with or without children). The survey results also showed that factors related to “hassle”, such as rearranging their work hours to allow for participation, negatively affected active participation in meeting events. These results suggest that factors affecting hospital staff participating in these events may, in part, be implicated in professionalism as medical staff, and that this can be influenced by job type and motivation, rather than by environmental factors.

　　This study sought to examine the impact of the approaches being taken to deal with current problems between the hospital and staff from the viewpoint of organizational identity. First, we devised educational strategies that allowed staff to speak directly to the hospital director. Next, the director spoke to staff about the background and history, the basic philosophy, and the vision of the hospital, as well as their place and mission in the community. We also conducted a 7-item questionnaire survey (1-5 graded Likert scale) of 894 staff from November 2012 to September 2013. Collection and response rates were 80.3% each. Regarding the direct communication between our hospital director with staff, response to the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood one's place and mission in the community” were significantly increased after the on-the-job training compared with before receiving the training. We confirmed that about 90% of staff understood the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood their place and mission in the community”. Also, two factors, “organizational identity” and “a sense of distance from the hospital organization”, were extracted from the 7 questions for factor analysis. The reliability of this scale was high and showed high internal consistency (Cronbach's α coefficient＝0.837 and 0.670, respectively). The results of these tests for validity of the scale indicate its high content validity. Together, these results suggest that direct communication between our hospital director and staff was extremely useful for penetrating the organizational environment and enhancing staff's organizational identity.

　　This study sought to elucidate factors that affect the cultivation of organizational identity among our hospital staff. We conducted a questionnaire survey among hospital staff (N＝894) from November 2012 to September 2013. The following items were queried: job category, age, sex, marital status, with or without children, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis. The response rate for the survey was 80.3%. Univariate analysis showed that all abovementioned parameters affected the cultivation of organizational identity. Further study using multivariate logistic regression analysis was performed to clarify which factors are significantly involved in the cultivation of organizational identity. Our results show that job category, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis are effective in cultivating organizational identity. These results suggest that a sense of professionalism as medical staff may play a critical role in the cultivation of organizational identity.

　The number of medical staff who can conduct clinical research in our hospital has been decreasing every year, and thus education that enhances medical staff's understanding of the importance of clinical research is an important factor in improving patient management. Although staff education has begun to develop infrastructure necessary for conducting clinical research, it is unclear whether medical staff who must play a critical role in clinical research are actually interested in conducting research and participating in research-related educational programs. We carried out a cross-sectional questionnaire survey of medical staff to determine their interest in clinical research activities and related education. Of 894 medical staff who participated in a workshop at Anjo-Kosei Hospital, 718 responded to the survey (response rate: 80.3%), 24.9% of whom had experience in clinical research and 51.0% had an interest in the field and related data analysis. Furthermore, 51.0% of respondents showed demonstrable intention to participate in staff education. Such intention to participate was particularly obvious among clinicians, pharmacists, registered dietitians, radiologists, and rehabilitation therapists. Also, staff in their 30s and 40s were frequently interested in conducting clinical research and related data analysis. This suggests that these staff prefer a research environment where they can undertake clinical research soon after completing clinical training. Moreover, regarding the question of specific educational areas, statistical methods for data analysis garnered the highest interest, followed by methods of writing a research paper, use of statistical software, data interpretation, designing research, and identifying research topics. Therefore, such educational programs should be flexible to suit medical staff who perform data analysis as well as clinical research.

¹²³I-meta-iodobenzylguanidine (MIBG) has become widely applied in Japan since its introduction to clinical cardiology and neurology practice in the 1990s. Neurological studies found decreased cardiac uptake of ¹²³I-MIBG in Lewy-body diseases including Parkinson's disease and dementia with Lewy bodies. Thus, cardiac MIBG uptake is now considered a biomarker of Lewy body diseases. Although scintigraphic images of ¹²³I-MIBG can be visually interpreted, an average count ratio of heart-to-mediastinum (H/M) has commonly served as a semi-quantitative marker of sympathetic activity. Since H/M ratios significantly vary according to acquisition and processing conditions, quality control should be appropriate, and quantitation should be standardized. The threshold H/M ratio for differentiating Lewy-body disease is 2.0-2.1, and was based on standardized H/M ratios to comparable values of medium-energy collimators. Parkinson's disease can be separated from various types of parkinsonian syndromes using cardiac ¹²³I-MIBG, whereas activity is decreased on images of Lewy-body diseases using both ¹²³I-ioflupane for the striatum and ¹²³I-MIBG. Despite being a simple index, the H/M ratio of ¹²³I-MIBG uptake is reproducible and can serve as an effective tool to support a diagnosis of Lewy-body diseases in neurological practice.
3-Iodobenzylguanidine ; Cardiology ; Dementia ; Diagnosis ; Japan ; Lewy Bodies ; Lewy Body Disease ; Neurology ; Nuclear Medicine ; Parkinson Disease ; Parkinsonian Disorders ; Quality Control