Patients with heart failure often have difficulty in stopping cardiotonic drugs as the disease stage progresses, and long-term hospitalization is a factor that significantly reduces quality of life. To solve this problem, in September 2017, our hospital started an initiative to support overnight stays at home by using a portable precision infusion pump and continuously injecting cardiotonic drugs with the approval of the hospital’s medical ethics committee. Since there are few case reports of similar efforts in Japan, here we describe the use of drugs and the content of the intervention by pharmacists. The drug is administered via a peripherally inserted central venous catheter using an ambulatory precision infusion pump. The pharmacist calculates the drug dose and flow rate required during the at-home period using spreadsheet software, and proposes a prescription to the doctor. In addition, if multiple cardiotonics and diuretics are administered, the presence or absence of compounding changes is confirmed, and the feasibility of mixing should be examined, and then prepared aseptically on a clean bench on the day of administration. We started to administer catecholamine while in the hospital on the day before the stay at home. Then we prepared the catecholamine in a portable precision infusion pump and administered it during stay at home. To date, we have supported 8 cases in stays at home without emergency hospitalization or sudden death due to exacerbation of heart failure.

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

A new radiation system known as the TomoTherapy Radixact X9 was introduced at our hospital in June 2021. From August 2021 to March 2022, 6 patients underwent total body irradiation (TBI) with tomotherapy with the Radixact X9. This paper describes the sequence of events from treatment planning computed tomography to irradiation. Results are also reported for measurements made with Gafchromic EBT3 film, the Delta4 Phantom+, and an A1SL ionization chamber dosimeter, set-up error, and time required to enter and exit the room, which were measured during plan verification. The measurement results were as follows: Gafchromic EBT3 film, 91.78±0.96% ; Delta4 Phantom+ head, 100±0% ; chest, 98.93±1.17% ; foot, 98.90±2.28% ; ionization chamber dosimeter A1SL, -0.39±0.70%; Residual error: -0.01±1.91 mm for lateral, 0.29±1.60 mm for longitudinal, 0.36±2.07 mm for vertical, -0.06±0.78° for roll. In addition, the time required to enter and exit the room was 98.50±17.17 min. TBI could be performed within set-up error of 5 mm in all cases. The validation results from the initial 6 cases confirmed that TBI with tomotherapy provided good dose distribution and positional accuracy.

We are under pressure to reform the social security system and work styles. To realize these reforms and basic principles, we need to understand the current environment surrounding the hospital and consider future measures. We report on the problems identified as a result of our investigation of the medical environment in the South West Mikawa West Medical Region and our hospital, and propose the use of emergency medical technicians (EMTs) as a solution to these problems. We examined data from the National Census, the Japan Medical Association Research Institute for General Policy Studies, the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, and our hospital’s management meeting. In this medical area the population aged 65 years or older and the demand for medical care are projected to increase toward the year 2045. On the other hand, the number of physicians and nurses per 100,000 population in this medical region is below the national average. Almost no change was seen in the number of patients coming to the hospital by ambulance or the number of emergency admissions by ambulance, and their admission rates did not change significantly over the past 5-year period. However, the rate of unfilled ambulance demand increased, due to the impact of full beds. Of the total number of emergency ambulance admissions, the rate of moderately ill patients averaged 74% over the 5-year period. The number of inpatient transfers in 2022 decreased by 25.5% (176) compared to that in 2019 due to the lack of personnel to transport patients. As the demand for medical care increases toward 2045, we need to reduce the rate of unfilled ambulance demand while at the same time reforming work styles to create a more comfortable workplace for healthcare workers. To achieve these goals, key tasks may be to review the transfer transport system for moderately ill patients and to expand the role of EMTs.

A man in his 60s was found to have a tumor shadow in the anterior mediastinum on computed tomography (CT) performed for examination of other diseases. The tumor had poor contrast enhancement with some calcification and was considered benign. Therefore, the decision was made to observe the tumor. Six months later, CT showed enlargement of the lesion, and malignancy could not be ruled out, so mediastinal tumor removal was performed. Histopathological examination revealed a diagnosis of cavernous hemangioma. Mediastinal hemangioma is a rare disease, and it has been reported that there is a possibility of recurrence after surgery even in the absence of malignant findings, so complete surgical resection and follow-up observation are considered necessary. This report includes a literature review.

A 34-year-old man had been diagnosed with ileocolonic-type Crohn's disease at the age of 27 years. He had undergone a wait-and-see partial ileal resection and an ileocecal resection for an intestinal fistula, and clinical remission was maintained with the maximal dose of infliximab and azathioprine. The patient developed a sore throat, fever, and rash that spread from the face to the rest of the body, and he was admitted to the hospital with liver dysfunction. Varicellazoster virus infection was found, and acute liver failure developed due to a rapid decrease in hepatic reserve. Visceral disseminated varicella-zoster virus infection was strongly suspected. After antiviral therapy and steroid pulse therapy, the liver failure became mild and the patient was discharged from the hospital. It should be noted that fatal infections can occur in patients with inflammatory bowel disease on immunosuppressive drugs.

Fever is a major symptom of Kawasaki disease, occurring in 99.5% of patients. We report a case of coronary artery aneurysms without fever in an 8-month-old male infant, who was referred to our department on the 8th day of illness for evaluation of red eyes and erythema at the BCG vaccination site. On the 16th day of illness, he was referred again to our department with membranous debris on his fingers. Cardiac ultrasonography revealed coronary artery aneurysms (#1, 3.9mm [Z=6.68]; #5, 3.3mm [Z=4.96]), and we diagnosed incomplete Kawasaki disease. Coronary angiography performed at the age of 1 year (3 months after disease onset) showed regression of coronary artery aneurysms #1 and #5 to 2.1mm (Z=2.12) and 2.1mm (Z=1.33), respectively; therefore, administration of anticoagulants and antiplatelet agents was discontinued. Considering the possibility of incomplete Kawasaki disease, comprehensive evaluation of coronary artery lesions is warranted even in afebrile patients who present with red eyes and erythema at the site of the BCG inoculation.

A 43-year-old woman was admitted to our hospital due to type 2 diabetes, dyslipidemia, and hypertension. Her triglyceride levels remained around 300-500 mg/dl with oral administration of pemafibrate and omega-3-acid ethyl esters granular capsules. Her diabetes and dyslipidemia had worsened since winter 2023, and at the time of her regular visit in February 2024, her triglyceride level had worsened to 4926 mg/dl. She developed epigastric pain at noon on the day after her regular outpatient visit. Although she was treated with over-the-counter medication for 1 day, there was no improvement and she was referred to our hospital. A computed tomography scan revealed swelling of the pancreatic head and fluid collection up to the right side of the perirectal space, and she was diagnosed with severe acute pancreatitis. Her triglyceride level decreased and her clinical symptoms improved with large-dose fluid replacement, meropenem injection, ulinastatin infusion, and continuous intravenous insulin and heparin infusion. In this case, acute pancreatitis was thought to be induced by worsening diabetic control, which was associated with an increase in triglycerides. Continuous intravenous injection of insulin and heparin was useful for treatment.

The patient was an 86-year-old woman and a former war-displaced orphan with limited proficiency in Japanese. She resided in a care facility and independently managed her basic activities of daily living. She had been diagnosed with type 2 diabetes mellitus 3 years earlier, maintaining HbA1c levels around 7.0% through dietary and exercise therapy. Her relatives regularly provided her with sweets and beverages. Oral prednisolone 7.5 mg had been initiated 28 days prior to admission for dermatitis and was tapered to 5 mg 14 days earlier. Two days before admission, she experienced a loss of appetite, and on the day of admission, she presented to the emergency department with choreiform movements of the left upper and lower limbs. Brain magnetic resonance imaging revealed no abnormalities associated with the involuntary movements. Random blood glucose was 802 mg/dL. She was hospitalized and treated with insulin, achieving glycemic control. Insulin therapy was discontinued, and she was discharged on day 8 with oral hypoglycemic agents. Potential mechanisms of chorea included diabetic chorea and cerebral ischemia. While steroid-induced glucose intolerance is typically associated with high doses or prolonged use, this case highlights that even low-dose, short-term steroid therapy can impair glucose tolerance, particularly in elderly patients, necessitating greater caution.

Half a century has passed since the normalization of diplomatic relations between Japan and China, and there is an urgent need to consider home care for elderly Chinese returnees in Japan. The purpose of this study was to clarify problems and needs in home care support for Chinese returnees as ascertained from caregivers’ experiences. Participants were representatives of 94 long-term care insurance service offices in the Kanto region that were able to provide care services in Chinese, and a questionnaire survey was conducted by mail. Seventeen facilities that provide long-term care services to Chinese returnees now or within the past 2 years were included in the analysis. 8 (47%) of the service offices were “day-care centers” or “communitybased day-care centers”, and 10 (59%) were in Tokyo. The number of offices with “less than 5” Chinese-speaking staff was 13 (76%). The major home care problems were differences in language and culture, and four categories were extracted: [weak community living infrastructure], [mental and cognitive problems], [family caregiving difficulties], and [difficulties in providing formal care]. Various [requests for enhanced home care support] was identified, including requests for increasing Chinese-speaking staff and care facilities, as well as for more financial support from the government.