Daily Medical Care Research Articles

A Questionnaire Survey on Daily Medical Care Problems at Special Schools for Severely Neurologically Impaired Students in Southern Fukuoka Prefecture

A Questionnaire Survey on Daily Medical Care Problems at Special Schools for Severely Neurologically Impaired Students in Southern Fukuoka Prefecture

Ethical issues in the daily medical care of children

The main ethical imperative of all paediatric actions is the demand to do everything "in the best interests of children". Relevant guidelines can be derived from the UN Declaration on the Rights of Children, whereupon every child has the fundamental right to life and dignity, and is entitled to optimal medical care. Paediatric care in general includes the responsibility to achieve the highest level of knowledge, consideration of the child-specific somatic, mental and social development, empathic and trustworthy communication with the child and parents, observance of the recommendations of the Charter of the Rights of Children in Hospital, and cooperation with experts in related professions. Good communication is based on respect for the dignity of the child as a person and on the use of child-specific language, recognizing the rights of the child to be involved in consent or assent. Good clinical practice dictates and demands high standards of practice in therapeutics, research and medical interventions involving children. Decision making in extreme situations with regard to continuation, withholding or withdrawing life supporting measures is amongst the most complex and ethically difficult tasks of a doctor. Ethical issues with regard to neglect, maltreatment, abuse and addictions involving children need scrupulous consideration. Paediatricians have a prime responsibility to promote and protect the well being of children.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usally in the daily medical care. 2. Mycoplasma penumonia.

マイコプラズマ肺炎の発生数は毎年増加傾向にあり,最近では市中肺炎の原因菌として肺炎球菌についで頻度が高い.マイコプラズマ肺炎の診断は主に血清学的になされているが,迅速性に欠けることからここ数年来臨床像からみた診断が試みられている.また画像解析の進歩に伴い,典型的なマイコプラズマ肺炎のCT像も明らかにされている.一方,治療面においては, 2000年以降各地域において薬剤耐性マイコプラズマが分離され,その増加と耐性動向が注目されている.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usally in the daily medical care. 3. Chlamydia pneumonia.

クラミジア肺炎は内科領域の日常診療ではよく経験されるが,中でも肺炎クラミジア肺炎は市中肺炎の約1割と頻度が高い.血清診断が比較的簡便にできるようになったので積極的な診断と治療が望まれる.オウム病は比較的まれではあるが,重症肺炎の中で重要であり,問診,臨床像等からトリとの関連を疑えば迅速な治療が必要である.本稿ではクラミジア肺炎の診断と治療の現状について述べた.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usally in the daily medical care. 5. Influenzal pneumonia.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usally in the daily medical care. 5. Influenzal pneumonia.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usally in the daily medical care. 4. The Legionella pneumonia.

レジオネラは市中肺炎の主要起因菌であり,院内肺炎にも関与することがある.従来は予後の悪い肺炎とされてきたが,近年の新しい診断法(尿中抗原検査法)や治療薬(ニューマクロライド薬,レスピラトリーキノロン薬)の開発により,予後は劇的に改善している.通常の細菌検査ではレジオネラの検出が困難であることから,得られた臨床情報より早期にレジオネラ肺炎を疑い,検出のための検査を施行できるか,が重要である.

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usually in the daily medical care. 1. Bacterial pneumonia ( focusing on the pneumococcal pneumonia ).

Pneumonia : Advance on diagnosis and treatment. I. Pneumonia observed usually in the daily medical care. 1. Bacterial pneumonia ( focusing on the pneumococcal pneumonia ).

Risk Factors for Hospital-acquired Bacteremia

Bacteremia is one of the most serious health problems associated with high morbidity and mortality. The aim of this study was to identify risk factors for bacteremia in daily medical care to facilitate rapid and accurate clinical decisions about treatment. We studied 306 inpatients retrospectively. Age, peripheral neutrophil count, C-reactive protein (CRP), platelets, serum total cholesterol, total protein, albumin and cholinesterase were compared in patients with positive- and negative-blood cultures. The associations between blood culture positivity and glucose tolerance, bedridden state, presence of a central venous catheter (CVC) or urinary catheter were examined. On October 14, 2002, strategies for prevention of catheter-related infection were altered in our hospital. We studied the impact of these changes on the risk of bacteremia. Sixty-seven patients had positive and 239 had negative blood cultures. Age, neutrophil, platelets, total protein, albumin, and cholinesterase were significantly different between the culture-positive patients and the culture-negative patients. Multivariate analysis showed albumin and platelets as independent predictors. The bedridden state and catheter-inserted states (central venous or urinary) conferred significantly higher positive blood culture rates. Multivariate analysis showed using urinary catheters and indwelling femoral CVCs as independent risk factors. There was no significant difference in the blood culture-positive rate before and after the change in prevention strategies; before the change, 6 of 9 catheter-inserted blood culture-positive cases yielded MRSA, while 4 of 12 cultures yielded Staphylococcus epidermidis after the change. Our study highlights the risk factors of bacteremia in vulnerable patients.

SCI-Base: an open-source spinal cord injury animal experimentation database.

To capture all pertinent data during spinal cord injury animal experimentation, the authors have designed and implemented a database that is available for use under a public license. Their goals were to record all daily medical care of paraplegic animals, including unexpected complications; to store all injury parameters and/or therapeutic procedures; to track locomotor scores and other measures of functional recovery; to allow planning and management of experiments; and to serve as an externally linkable, SQL-queryable data mining source. Ultimately, the use of databases such as this will allow multiple neurotrauma laboratories to compare animal data through web meta-analysis.

Actions to Improve Daily Medical Care for Children with Severe Neurological Impairment in School and Community Life

Actions to Improve Daily Medical Care for Children with Severe Neurological Impairment in School and Community Life

The concept of severe osteoporosis

In diagnostic criteria of primary osteoporosis in Japan, there is no expression of severe osteoporosis. In the primary osteoporosis, the criteria of WHO is difficult to use in our daily medical care. In 1992, we opened "The osteoporosis dock" in the department of osteopaedics of National Nishisaitama Chuo Hospital. From experience of our osteoporosis dock, we tried to answer the question with "what is the concept of severe osteoporosis?".

Continuous geriatric care in orthopedic wards: a valuable alternative to orthogeriatric units.

The aim of this study was to assess whether assigning a geriatrician to provide daily medical care to geriatric patients in the orthopedic ward can improve the prognosis and reduce the length of stay. Time series analysis was performed in two parts: 1) prospective analysis of two years' workload, and 2) retrospective analysis of data collected over the 4 years prior to the intervention. Intervention and control populations were pooled, and the effects of geriatric care and patient-related factors on outcome measures were assessed by logistic regression analysis. All subjects were patients aged > or = 70 years who attended the orthopedic ward in a university hospital in years 1989-90 (studied group: 287 cases) and in years 1985-88 (control group: 474 cases). In the study period, mortality was 8.4% compared to 18% in 1985-86 (p < 0.0006) and 14% in 1987-88 (p < 0.01). The operation rate in the study period was 89.9% vs 83.8% in 1985-86 (p < 0.02) and 81.8% in 1987-88 (p < 0.005). Length of stay was 26.2 +/- 14.4 days vs 32.9 +/- 30.9 days in 1985-86 (p < 0.05) and 26.9 +/- 16.5 days in 1987-88 (NS). Length of stay was more strikingly shortened in the subset of patients with femoral fracture undergoing surgical management (28.5 +/- 12.7 vs 37.6 +/- 32.6 days in 1985-86, p < 0.003, and 30.8 +/- 15 days in 1987-88, p < 0.02). Given the positive relationship between geriatric care and operation rate (o.r. = 1.5, CI = 1.1-1.9), the protective effect of surgical treatment on mortality (o.r. = 0.6, CI = 0.4-0.8) to some extent may mask the collinear effect of geriatric care. We conclude that assigning a geriatrician to assist with the medical care of elderly orthopedic patients in orthopedic wards is associated with increased operation rate, decreased mortality and shortened length of stay.

TWO CASES OF TRANSCUTANEOUS REMOVAL OF IVH CATHETER FARGMENTS IN THE RIGHT SIDE CIRCULATORY SYSTEM

In this paper two cases that IVH catheter fragments in the right side circulatory system were transcutaneously removed are reported. Case 1 is an 18-year-old man who was hospitalized for traumatic intracerebral hemorrhage. He pulled out a IVH catheter indwelling in the right subclavian vein by himself, when the catheter was broken and the fragment of it entered through the supra vena cava into right side circulatory system. Case 2 is a 47-year-old woman hospitalizing for cerebral infarction. She also pulled out the catheter by herself. In both cases, catheter fragments were transcutaneously removed by using a basket catheter via the right femoral vein.It is probable that IVH catheter frequently entered into right side circulatory system in daily medical care. In Japan, only 51 cases that IVH catheter fragments in the right side circulatory system were transcutaneously removed have been reported. The most common mechanism for loss of the catheter was iatrogenic (14 cases), followed by spontaneous break by patients (8 cases). In the all 51 cases the mean age was 47 years and the male-to-female ratio was 2:1, versus 58 years and 5:1 in spontaneous break cases. It can be said that spontaneous break commonly occurred in aged men. In Japan snare loop catheters via the right femoral vein are most commonly used for removals of fragments.

Do-lt-Yourself Medical Testing: More Than 160 Tests You Can Do at Home

One of the reasons physicians are licensed by the state is to prevent people from untrained quackery. Another is to prevent them from themselves. This book by Pinckney and Pinckney is noxious in both respects and ignores the Chinese: a physician who treats himself has a fool for both a patient and a doctor. Dr Edward Pinckney, a one-time assistant editor of The Journal and a fellow of the American College of Physicians, has created a monster for those of us in the trenches who provide daily medical care. Do-It-Yourself Medical Testing begins with the premise that there is nothing new about home medical testing, but in 266 pages encourages the layman to establish a home clinical lab that would make most primary care physicians envious. The book is written to slake the thirst of the American public in second-guessing the physician and represents unabashed literary profiteering. The husband-and-wife authors