Watanabe J.,Tottori Prefectural Cyuo Hospital |
Nishimura K.,Tottori Prefectural Cyuo Hospital |
Miyasaka S.,Tottori Prefectural Cyuo Hospital |
Morimoto K.,Tottori Prefectural Cyuo Hospital |
And 2 more authors.
International Journal of Angiology | Year: 2015
Heparin-induced thrombocytopenia (HIT) is still a relatively uncommon condition and it is not well known how to administer argatroban during continuous hemodiafiltration (CHDF). A 72-year-old man required CHDF with heparin because of the oliguria and hyperpotassemia directly after the open repair of a juxtarenal abdominal aortic aneurysm. As the postoperative blood platelet count dropped and there was a thrombus in the CHDF circuit, HIT was suspected and nafamostat mesilate, but not heparin, was immediately administered for CHDF. As heparin-platelet factor 4 complex was positive, we diagnosed him with HIT and started argatroban while monitoring the activated clotting time (ACT), resulting in no further obstruction of the CHDF and an increase in the platelets. There was no disadvantage for administering nafamostat mesilate which we have commonly used instead of heparin, we should have used argatroban once we suspected HIT. It may be important to consider the history of heparin especially in administering heparin and it may be useful to monitor the ACT when initially starting argatroban for patients with HIT. Copyright ©, Thieme Medical Publishers. All rights reserved.
Kambara E.,Fukuyama Medical Center |
Hirata M.,Fukuyama Medical Center |
Kashiwabara Y.,Fukuyama Medical Center |
Yamakawa F.,Fukuyama Medical Center |
And 7 more authors.
IRYO - Japanese Journal of National Medical Services | Year: 2015
This study analyzed the effect of rooming-in care versus mother-infant separate care on the success of breast-feeding in our hospital.Data based on 39 infants in rooming-in and 62 infants in separate care showed a tendency of decrease in rooming-in (p<0.10) in the aspect of full breast feeding rate, compared with separate care at 1 month helth check. No significant differences were demonstrated, however, on decline in abandonment of children and maternal anxiety, assessed by MAI-J and MCQ score, respectively. The Questionnaire in in rooming-in care system showed that there were some discrepancies between images and practical experiences. WHO/UNICEF declared that mother-infant separation care raises maternal insecurity, decreased breast feeding and deprives the baby from mother's love. Our results demonstrated that careful considerations such as frequent visits and nursing instructions should be needed to fulfil the ideal goals of rooming-in care system. © 2015, Japanese Society of National Medical Services. All rights reserved.
Kawamoto T.,Kure Medical Center |
Kouno Y.,Kure Medical Center |
Kanme S.,Hamada Medical Center |
Okamoto N.,Kure Medical Center |
And 3 more authors.
IRYO - Japanese Journal of National Medical Services | Year: 2013
Background : Although regional medical liaison office (RMLO) manages support collaboration between the hospital and clinics, there were many problems in the referral system. Objective : To clarify the effect of improvement on problems of the referral system in RMLO. Subjects : In NHO Kure Medical Center, complaint reduction projects were carried out, which consisted of improvement of referral letters distribution, triage sheet for emergency, and computerized referral management system, and consultation systems for undetermined referrals. The complaints in the RMLO were compared before and after the implementation of the project. Results : The monthly average number of troubles were reduced significantly from 14 ± 6.9 to 5.6 ± 4.5 (p < 0.01 ) The ratio of the trouble cases to the total count of referral letters was significantly decreased from 1.0 ±0.5% to 0.4 ±0.3%. The complaint sources from primary care physician were 61, hospital doctor 54 and patients 29, which was changed to 22,24 and 3, respectively (p=0.04). The contents of complaints were different from before and after the project significantly (p <.0001), in particular, for primary care physicians the number of the undetermined specialist for referral was reduced from 25 to 0 and reply for the referrals was from 16 to 7. For hospital doctors, the problems of referral letters were reduced from 24 to 3 and referrals for undetermined specialists were from 14 to 3. Conclusion : Work performance and information and communication technology system have contributed to the improvement of the referral management and the reduction of complaints from primary care physicians and specialists.
Ishihara S.,The University of Shimane |
Yashima K.,Tottori University |
Kushiyama Y.,Red Cross |
Kawashima K.,Matsue Seikyo Hospital |
And 14 more authors.
Journal of Gastroenterology | Year: 2012
Background: It remains unknown whether the Rome III criteria can exclude organic colonic lesions prior to the diagnosis of irritable bowel syndrome (IBS). We evaluated the colonoscopy results of patients meeting the Rome III criteria for the diagnosis of IBS to determine the presence of organic colonic lesions. Methods: This study was prospectively conducted at 17 centers in Japan. We enrolled 4528 patients who underwent diagnostic colonoscopy examinations. The diagnosis of IBS was evaluated by questionnaire results according to the Rome III criteria. Results: We evaluated 4178 patients (350 were excluded because of incomplete data or previous colonic surgery), of whom 203 met the Rome III criteria (mean age 57.9 years; range 14-87 years) prior to the diagnostic colonoscopy examination. We identified organic colonic diseases in 21 of these 203 patients (10.3 %), and these disease were also identified in 338 (8.5 %) of 3975 patients who did not fulfill the Rome III criteria. There were no differences in regard to the prevalence of organic colonic diseases between patients who did and did not fulfill the Rome III criteria. Conclusions: The prevalence of organic colonic diseases in patients who met the Rome III criteria was at an acceptably low level, indicating that the Rome III criteria are adequately specific for the diagnosis of IBS without performing a colonoscopy examination. © 2012 Springer.
Tatebe S.,Tottori University |
Tatebe S.,Red Cross |
Tsujitani S.,National Center for Global Health and Medicine |
Nakamura S.,Tottori Prefectural Central Hospital |
And 7 more authors.
Gastric Cancer | Year: 2014
Background: The Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer established oral S-1 administration for 1 year as the standard postoperative adjuvant chemotherapy for gastric cancer in Japan. We conducted a multicenter cooperative prospective study comparing daily and alternate-day S-1 administration as postoperative adjuvant therapy for gastric cancer. Methods: Patients with Stage II or III gastric cancer who underwent curative surgery were randomly assigned to receive standard daily S-1 administration [group A: 80-120 mg/day S-1 depending on body surface area (BSA); days 1-28 every 6 weeks for 1 year] or alternate-day administration (group B: 80-120 mg/day S-1 depending on BSA; alternate days for 15 months). Treatment completion rate was the primary endpoint, and relative dose intensity and safety, overall survival, and relapse-free survival (RFS) were secondary endpoints. Results: Seventy-three patients were enrolled. The treatment completion rate was 72.2 % in group A and 91.8 % in group B; the relative dose intensity was 67.5 % in group A and 81.2 % in group B; and compliance was better in group B. Digestive system adverse effects were less frequent in group B than in group A. Median follow-up time was 2.8 years; 3-year survival rate was 69.6 % in group A and 87.3 % in group B; and 3-year RFS rate was 76.4 % in group A and 73.1 % in group B. Conclusions: Our data show improved compliance and fewer adverse effects with alternate-day S-1 administration, which appears to be a more sustainable option for adjuvant chemotherapy for Stage II or III gastric cancer. © 2013 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.