抗がん剤用安全取扱器具 ＰｈａＳｅａｌ ｓｙｓｔｅｍの操作性の評価

We investigated the current situation and problems associated with dental treatment for patients with neuromuscular intractable diseases at medical institutions in Japan. Questionnaires were sent to 658 dental medicine institutions nationwide.Between October 25 and December 31, 2021, we targeted dental hospitals, dental and oral surgery departments from university hospitals, and dental treatment facilities registered with the Japanese Society of Disability Dentistry that had pediatric dentistry, disability dentistry, or eating function therapy departments. A questionnaire survey was conducted on the following topics: whether or not the dental clinic had experience in treating patients with neuromuscular disorders, breakdown of diseases and annual number of patients, oral symptoms, treatment content, frequency of hospital visits, problems faced by patients and their families in terms of dental treatment, and points that dental healthcare professionals pay particular attention to when treating patients. Responses were received from 215 facilities. Muscular dystrophy was the most common disease affecting patients who were treated in the course of a year, accounting for approximately 40% of the total. The most common oral symptom was periodontitis, and the treatment for it consisted of oral care (including removal of tartar and plaque), performed in approximately half of the patients, followed by general dental treatment and swallowing training. Oral care was carried out regularly. The main problems faced by the patients were difficulties with self-care on the part of the patients and their families, and difficulties with attending hospital appointments due to a lack of social support. Lack of acceptance at local dental clinics was also mentioned. Treatment considerations that required particular attention from the medical staff were the most frequent, with the most common being adequate positioning to prevent aspiration and ensure appropriate suction. In addition, a third party was requested to accompany the patient when attending hospital appointments, and vital signs were checked during treatment. Many patients with neuromuscular syndromes have oral diseases such as periodontitis and dental caries, as well as dysphagia, and require the intervention of dentists. However, dental professionals may not always be prepared to accept these patients. It is urgent for dentists to deepen their knowledge about the appropriate treatment for these patients and build a system capable of accepting them, while maintaining close cooperation with the medical profession.

Aim: This study examines the interrelationship between medical staff's sense of medical care policy alienation (SPA) and their subjective career success and the potential mediating roles of occupational calling (OC) and job satisfaction. Background: Medical staff's pivotal role in medical care policy implementation outcomes underscores their approach to career success, which affects work efficiency, and willingness to implement medical care policy. Effective policy is anticipated to be positively and rationally implemented, fostering favorable perceptions and career success among policy executors such as medical staff. However, limited research examines the relationship between career outcomes and medical staff's SPA. Methods: A cross-sectional study conducted from May to June 2023 collected data from 521 medical staff in 14 hospitals in northern, western, and southern China through questionnaire surveys. The questionnaire measured their SPA, OC, job satisfaction, and career success. A chain multiple mediation model was constructed to explore SPA's relationship with medical staff's OC and job satisfaction, resulting in less career success, and whether work overload moderated this relationship. Results: Medical staff's SPA was negatively related to career success via a chain mediation mechanism involving OC and job satisfaction. Work overload did not moderate SPA's negative association with OC; however, it moderated its association with job satisfaction. High workload intensified SPA's association with job satisfaction, increasing the mediating effect on career success compared to those with lower workloads. Conclusion: Medical staff's SPA was significantly negatively related to career success, reflected in a weakened OC, and decreased job satisfaction. Work overload somewhat moderated the relationship between SPA and job satisfaction. Policymakers and medical stakeholders should emphasize improved communication between medical institutions and staff, which is essential for crafting and disseminating medical care policies. Medical care policy implementation should be enhanced in diverse Chinese contexts to enrich the understanding of medical policy management.

Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation

ObjectiveTo provide a decision-making basis for sustainable and effective development of cervical cancer screening.MethodsThis cross-sectional study assesses the service capacity to conduct cervical cancer screening with a sample of 310 medical staff, medical institutions and affiliated township health centers from 20 county-level/district-level areas in 14 Chinese provinces in 2016.ResultsThe county-level/district-level institutions were the main prescreening institutions for cervical cancer screening. More medical staff have become engaged in screening, with a significantly higher amounts in urban than in rural areas (P<0.05). The number of human papillomavirus (HPV) testers grew the fastest (by 225% in urban and 125% in rural areas) over the course of the project. HPV testing took less time than cytology to complete the same number of screening tasks in both urban and rural areas. The proportion of mid-level professionals was the highest among the medical staff, 40.0% in urban and 44.7% in rural areas (P=0.406), and most medical staff had a Bachelor’s degree, accounting for 76.3% in urban and 52.0% in rural areas (P<0.001). In urban areas, 75.0% were qualified medical staff, compared with 68.0% in rural areas, among which the lowest proportion was observed for rural cytology inspectors (22.7%). The medical equipment for cervical pathology diagnosis in urban areas was better (P<0.001). HPV testing equipment was relatively adequate (typing test equipment was 70% in urban areas, and non-typing testing equipment was 70% in rural areas).ConclusionsThe service capacity of cervical cancer screening is insufficient for the health needs of the Chinese population. HPV testing might be an optimal choice to fill the needs of cervical cancer screening given current Chinese medical health service capacity.

Objective: To investigate the current situation of exposure of solid particles in medical staff and the occurrence of related diseases, and to understand the distribution characteristics of occupational exposure and the influencing factors. Methods: In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province. A face-to-face questionnaire survey was conducted on the basic situation of the staff of the hospital, the status of exposure to occupational hazards and the health effects. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects. In August 2016, the stratified cluster sampling method was adopted to select three tertiary general hospitals with different regions, different administrative levels and departments in Shandong Province, which were in contact with the basic conditions and occupational hazards of the staff of the hospital. Current situation and health impacts were conducted face-to-face questionnaires. Two-class logistic regression analysis was used to analyze the relationship between medical staff's solid particle contact and occupational health effects. Results: The overall contact rate of solid particles of medical staff was 41.5% (1843/4 446) , and the solid particles with the highest contact rate were 28.2% (1254/4 446) of talc dust. There was a statistically significant difference in the contact rate of solid particles between medical staff of different occupations, current working age, education and hospital type (χ(2)=76.30, 41.26, 26.16, 188.97, P<0.05) . There were significant differences in the conditions and types of solid particles in different departments (χ(2)=740.23, P<0.05) . Compared with the control group, the incidence of allergic asthma, chronic tracheobronchitis and dermatitis was higher in the contact group medical staff (P<0.05) . Contact with zirconia dust, talc dust, cotton dust is a risk factor for dermatitis in medical staff (OR=2.09, 1.45, 1.34) ; exposure to zirconia dust and cotton dust is a risk factor for chronic tracheobronchitis in medical staff (OR=2.38, 1.66) ; exposure to zirconia dust, gypsum dust is a risk factor for allergic asthma in medical staff (OR=3.90, 1.52) . Conclusion: The contact rate of solid particles in medical staff is high, and there are many types of contact. Frequent contacted with solid particles is a dangerous cause of related diseases. The working environment of medical staff should be further monitored and be strengthen the targeted protective measures and regulatory systems for the exposure of medical personnel to solid particles.

Background and Aims In Japan, peritoneal dialysis patients are required to record daily dialysis information in continuous ambulatory peritoneal dialysis (CAPD) notes. However, as the CAPD notes are a list of numbers, it is difficult for medical staff to quickly understand the patient's physical condition. Although many people now use communications infrastructure, access to medical information on the Internet is restricted from the viewpoint of patient information security in medical institutions in Japan. Therefore, patient information outside the medical institution cannot be viewed on the system inside the medical institution. Therefore, we are developing a safe and secure dialysis support system to connect dialysis patients’ homes and medical institutions. We have developed a dialysis support system that can share the patient's vital data, dialysis records, meal records, etc., between patients and medical institutions. Here, we added a function to support the exercise of dialysis patients, and present the results of a trial. Method The display and recording items of the previously developed system include vital data, and exchange start time as records necessary for peritoneal dialysis, dialysate concentration, drainage volume, fluid injection volume, drainage volume, drainage time, drainage confirmation, blood pressure, and blood sugar level. In addition to these items, we have added a new function to the system that can automatically input the patient's exercise records from ergo-storage device. This added functionality links movement information from the ergo-storage device with relevant patient information in the previously developed system. It also enables medical staff to view and share the graphical data as visible information from within the facility. The patients exercise using the developed ergo-storage device, and the amount of exercise is stored in the charger. Patients can exercise with this ergo-storage device on both dialysis and non-dialysis days. Results To prevent erroneous input, the dialysis records could be entered automatically or selected using radio buttons. In addition, when confirming drainage, it was possible to transmit images to medical institutions. In the added exercise function, the strength of pedaling on the ergo-storage device, the number of rotations, etc., could be output in CSV format. The amount of exercise was sent to the previously developed system. In addition, the system allowed storage of the electricity generated by rotating the pedals in the storage device. This added exercise function encouraged and sustained exercise in dialysis patients. It not only supported the patient's exercise, but also encouraged continuation by compensation for the amount of exercise via storage of electricity to charge devices. Therefore, the patients were motivated not only to exercise but also to continue to exercise. The accumulation of exercise data enabled the patients to understand changes over time, leading to self-management. Furthermore, exercise could be continued even on non-dialysis days. Medical institutions could also share not only the patient's dialysis records, but also information on their amount of exercise, leading to improved patient care. Conclusion This developed system with new exercise function supported patients’ exercise and its continuation on both dialysis and non-dialysis days. The amount of exercise by the patient was stored as electricity, which could be used to charge the patient's cell phone, etc. This increased the patients’ motivation to exercise. Furthermore, this information can be shared with medical institutions. This research was supported in part by Gakushin Kaken (JP20H03982).

The biological safety cabinet is the one piece of laboratory and pharmacy equipment that provides protection for personnel, the product, and the environment. Through the history of laboratory-acquired infections from the earliest published case to the emergence of hepatitis B and AIDS, the need for health care worker protection is described. A brief description with design, construction, function, and production capabilities is provided for class I and class III safety cabinets. The development of the high-efficiency particulate air filter provided the impetus for clean room technology, from which evolved the class II laminar flow biological safety cabinet. The clean room concept was advanced when the horizontal airflow clean bench was manufactured; it became popular in pharmacies for preparing intravenous solutions because the product was protected. However, as with infectious microorganisms and laboratory workers, individual sensitization to antibiotics and the advent of hazardous antineoplastic agents changed the thinking of pharmacists and nurses, and they began to use the class II safety cabinet to prevent adverse personnel reactions to the drugs. How the class II safety cabinet became the mainstay in laboratories and pharmacies is described, and insight is provided into the formulation of National Sanitation Foundation standard number 49 and its revisions. The working operations of a class II cabinet are described, as are the variations of the four types with regard to design, function, air velocity profiles, and the use of toxins. The main certification procedures are explained, with examples of improper or incorrect certifications. The required levels of containment for microorganisms are given. Instructions for decontaminating the class II biological safety cabinet of infectious agents are provided; unfortunately, there is no method for decontaminating the cabinet of antineoplastic agents.

Objective: To investigate the mental health of clinical first-line medical staff in COVID-19 epidemic and provide theoretical basis for psychological intervention. Methods: The mental health status of the first-line medical staff was investigated by Self-rating Anxiety Scale(SAS) and Post-Traumatic Stress Disorder Self- rating Scale (PTSD-SS). From February 7 to 14, 2020, 246 medical staff participated in the treatment of COVID-19 were investigated using cluster sampling, and received 230 responses, with a recovery rate of 93.5%. Results: The incidence of anxiety in medical staff was 23.04% (53/230) , and the score of SAS was(42.91±10.89). Among them, the incidence of severe anxiety, moderate anxiety and mild anxiety were 2.17%(5/230) , 4.78%(11/230) and 16.09%(37/230) , respectively. The incidence of anxiety in female medical staff was higher than that in male [25.67%(48/187) vs 11.63%(5/43) , Z=-2.008, P=0.045], the score of SAS in female medical staff was higher than that in male [(43.78±11.12) vs (39.14±9.01) , t=-2.548, P=0.012]. The incidence of anxiety in nurses was higher than that in doctors[26.88% (43/160) vs 14.29% (10/70) , Z=-2.066, P=0.039], and the score of SAS in nurses was higher than that in doctors [ (44.84±10.42) vs (38.50±10.72) , t=-4.207, P<0.001]. The incidence of stress disorder in medical staff was 27.39% (63/230) , and the score of PTSD-SS was (42.92±17.88) . The score of PTSD-SS in female medical staff was higher than that in male[ (44.30±18.42) vs (36.91±13.95) , t=-2.472, P=0.014]. Conclusion: In COVID-19 epidemic , the incidence of anxiety and stress disorder is high among medical staff. Medical institutions should strengthen the training of psychological skills of medical staff. Special attention should be paid to the mental health of female nurses.

JMDC, Inc. (JMDC) has created a database, using data collected from medical institutions in Japan, consisting of claims (for hospitalization and outpatient treatment), diagnosis procedure combination (DPC) assessment forms, and clinical laboratory test values. The oldest data in this database that can be accessed relate to treatment in April 2014. Currently (the end of October 2019), the number of medical institutions is 218, consisting of 131 DPC‐eligible hospitals and 87 DPC‐ineligible hospitals. Using this database, it is possible to carry out an analysis that makes up for certain limitations of JMDC's another database of data from health insurance societies (eg, the disease status and test results cannot be ascertained, and there is insufficient access to data for elderly people). In addition, it is noteworthy that this database includes not only data from DPC‐eligible hospitals but also data from some DPC‐ineligible hospitals.

Research on psychological stress and mental health of medical staff in COVID-19 prevention and control

Studies of group interventions on social relationships among patients with cancer have suggested that such interventions can increase patients' social support and help build social support networks, which are expected to reduce the sense of loneliness among them. The purpose of this study was to qualitatively investigate the relationships between participation in group therapy and social relationships among patients with cancer. Seven participants with various types of cancer participated in group therapy and were interviewed at a medical institution in Japan. They were asked about changes in their social relationships after being affected with cancer and taking part in group therapy. We conducted qualitative analysis and identified 11 categories related to changes in social relationships after being diagnosed with cancer (e.g. “shrinkage or lack of social networks, weakening of density”). Six categories related to changes in social relations after taking part in group therapy were identified (e.g. “expanding support networks and increasing density”). The findings suggest that participation in group therapy may supplement the social relationships of patients with cancer who have experienced a reduction in, or insufficiency of, social relationships. In particular, we suggest that participants in group therapy might be receiving emotional/informational support and companionship from the other participants, including patients with the same disease, and from the medical staff.

No studies have been done on maintaining a class II biological safety cabinet in a sterile condition during the preparation of antineoplastic agents. Also, the relationship between maintenance of sterility and preparation time and that between time of irradiation with ultraviolet light (UV) and maintenance of sterility have yet to be studied. With this in mind, we examined the relationship between maintenance of sterility and preparation time in a class II biological safety cabinet and the variation in bacterial extinction with time of exposure to UV lamp irradiation. Regarding the former, we observed that no bacteria colonies were present 15 minutes after the start of antineoplastic agent preparation but from 30 minutes after the start of preparation onwards, a time-dependent increase in the number of colonies was observed. Colony formation did not vary with the part of the safety cabinet the Petri dish was placed in. UV irradiation for 30 seconds markedly suppressed colony formation as compared with the positive control group. We therefore suggest that every antineoplastic preparation be irradiated with for 5 minutes and that this is started 15 minutes after starting to prepare them in a sterile environment.

Background and Aims Although many people use communications infrastructure, direct connection of electronic medical records to the Internet is restricted at medical institutions in Japan. Therefore, patient information outside the medical institution cannot be viewed on systems inside the medical institution. We are developing a safe and secure dialysis support system that connects dialysis patients and medical institutions, which is separate from the system within medical institutions. We have developed a dialysis support system that can share vital data, dialysis records, meal records, etc., between patients and medical institutions. In this study, to support dialysis patients’ exercise and its continuation, we created an ergo-storage device combining an ergometer and storage device for this research and added functions to the existing dialysis support system. This system with additional exercise function could encourage patients to exercise, store the amount of exercise as the amount of electricity used, this electricity represented a reward to the patient for exercising. These additional features allow the patient to exercise at home on both dialysis and non-dialysis days. Method An ergometer was used as exercise equipment for dialysis patients with a hub dynamo to convert the rotations of the ergometer through a belt into electricity. This allowed the dynamo to take over the rotation of the ergometer. In addition, we developed a new circuit that converts the power generated by the dynamo to USB voltage. A simple USB voltage and current checker was added to allow the integrated power to be displayed making it possible to visualize momentum as power generation. In addition, the generated power could be stored in the USB charger. To record the amount of exercise of the patient, the information from the ergometer was output to a tablet in CSV format. This CSV file was sent to the developed system and linked with the patient information in the existing system. This system made it possible to visualize and display the exercise information along with the patient's daily dialysis information and meal information on the developed system. Results Momentum could be converted to electrical energy using the ergo-storage device. The patient could now see and store the amount of exercise they have done, enabling the patient to exercise on both dialysis and non-dialysis days. As the amount of exercise could be visualized at a glance, the patient was encouraged and prompted to exercise daily. In addition, as the amount of exercise could be stored as electricity, this electricity represented a reward to the patient for exercising. The patients reported that it was good to be able to enjoy exercising instead of having a quota, and that they were able to continue exercising. Patients began exercising voluntarily instead of being forced to exercise by health care workers. In addition, it was possible to link the system with the patient's dialysis records and share the amount of exercise, making it easier for medical professionals to understand the patient's physical condition. Conclusion A function that allows dialysis patients to exercise was added to the developed system. Using this system, patients and medical institutions could share dialysis records, such as the patient's amount of exercise. The patients could exercise on both dialysis and non-dialysis days, and the amount of exercise and dialysis records could be shared with medical institutions. In addition, the amount of exercise was stored as electricity, which increased the patient's motivation to exercise. The patients began to exercise voluntarily. This research was supported in part by Gakushin Kaken (JP20H03982).

Objective: To investigate the current situation of safety protection of medical staffs in medical institutions in Jiangsu Province, and to provide scientific basis for strengthening the safety protection of infectious diseases and protecting the occupational health of medical staffs. Methods: From September to October 2020, 1274 medical staffs in 43 medical and health institutions were randomly selected as the subjects. The self-made questionnaire for infectious disease prevention and protection was used to analyze the pre-job training and exposure to occupational harmful factors of the respondents. The influencing factors of using protective equipment and occupational injury were analyzed by binary logistic regression. Results: A total of 1216 valid questionnaires were collected with effective recovery of 95.4%. There were 312 males (25.7%) and 904 females (74.3%) , with an average age of (35.8±9.2) years and average working years of (13.6±9.9) years. Among them, 1143 (94.0%) had participated in pre-job training, 535 (44.0%) thought they were exposed to occupational harmful factors of infectious disease prevention, 1082 (89.0%) used protective equipment in daily operation, and 462 (38.0%) had occupational injury. According to binary logistic regression analysis, the utilization rates of protective equipment for medical staffs in Centers for Disease Control and Prevention (OR=2.473, 95%CI: 1.327-4.607, P=0.004) , 30-39 years old (OR=1.586, 95%CI: 1.038-2.426, P=0.033) , 40-49 years old (OR=2.257, 95%CI: 1.243-4.098, P=0.007) , 50 years old and above (OR=5.879, 95% CI: 1.755-19.692, P=0.004) and pre-job training (OR=2.580, 95%CI: 1.301-5.116, P=0.007) were higher than their respective control groups. And medical staffs with graduate degree or above (OR=0.342, 95%CI: 0.167~0.699, P=0.003) had lower utilization rate of protective equipment. Female (OR=1.902, 95%CI: 1.364-2.654, P<0.001) , 30-39 years old (OR=1.589, 95%CI: 1.157-2.181, P=0.004) , bachelor degree (OR=2.070, 95%CI: 1.419-3.021, P<0.001) , exposure to occupational harmful factors (OR=2.753, 95%CI: 2.086-3.634, P<0.001) were the risk factors for occupational injury of medical staffs. Centers for Disease Control and Prevention (OR=0.129, 95%CI: 0.086-0.194, P<0.001) and wearing protective equipment according to regulations (OR=0.597, 95%CI: 0.431-0.827, P=0.002) were the protective factors for occupational injury of medical staffs. Conclusion: At present, the occupational injury rate of medical staffs in Jiangsu Province is high due to various factors in the prevention and control of infectious diseases. It is necessary to pay attention to occupational safety protection, strengthen pre-job training and actively advocate "standard prevention", so as to reduce the exposure risk of harmful factors and promote occupational health of medical staffs.

BackgroundWhile emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the “department-specific emergency care model” and the “emergency center model” are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients.ResultsA nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61–80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were “hospitals designated for residency training” and “facilities making some efforts to improve the quality of emergency care and the emergency medical system” (logistic analysis, P < .001).ConclusionRelevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.