Language:Japanese / English
2016y vol.16 Issue 1
Republish of The Medical Journal of Mutsu General Hospital Tadashi Hashizume
Review Articles
Postgraduate medical training in Mutsu General Hospital for twelve years
―Still learning on Prof.William Osler, “Medicine is an art, based on science”―
Tetsuhiro Sakai
Clinical training for residents (kenshuui) in Mutsu General Hospital (MGH) for thirteen years learning from Prof. William Osler. “Medicine is an art based on science”
Sixty one kenshuui completed MGH kenshuui program successfully, and fifty two out of sixty one kenshuui over twelve years entered the advanced and specialized program in Hirosaki University Hospital. The workshops regarding clinical ethics, which were carried out successfully, were introduced and discussed. Knowledge and thinking way of humanities and cultural science must play an important role of kenshuui training and education. Both kenshuui and faculty should learn from Prof. William Osler again.

Key words: William Osler, Postgraduate medical training, Cultural sciences

Original Articles
The impact of the medical fee revision in fiscal year 2014 on percutaneous endoscopic gastrostomy (PEG) in Fuyoukai Murakami Hospital
—The change of the rate of oral ingestion after PEG—
Yusaku Kajihara
I have conducted the examination of swallowing for many patients with dysphasia since the Japanese medical fee revision in fiscal year 2014, and investigated the increment of percutaneous endoscopic gastrostomy (PEG) leading to oral intake. I excluded 6 patients having obstruction due to head and neck cancer from 391 patients who were performed PEG in Fuyoukai Murakami Hospital from April 1, 2012 to March 31, 2015, and therefore my retrospective study included 385 patients. I compared the rate of partial or total oral intake after PEG between fiscal year 2012―2013 and 2014―2015, and it was revealed that the rate of fiscal year 2014―2015 was significantly higher than that of fiscal year 2012―2013 [7.5% (16/214) vs. 16.4% (28/171), p <0.01]. Several reasons were considered, including the detection of patients who could take orally by an evaluation of swallowing function, a possibility of tendency to avoid PEG for oral feeding difficulties except palliative care, and significant incremental disuse syndrome as the main cause of dysphasia [10.3% (22/214) vs. 18.1% (31/171), p <0.05].

Key words: Japanese medical fee revision, percutaneous endoscopic gastrostomy (PEG), rate of oral intake

Evaluation of collimator scatter factor measured by using several kinds of miniphantom in 10MV X-ray Yushi Nakanowatari
Tetsuzo Nara
Masafumi Takagi
Yasushi Mariya
Dose calculation has become complicated in the field of radiation treatment planning. Narrow radiation field is very important in this field. The aim of this study was to investigate the influence of combination of the size of radiation field and the external diameter of miniphantom (MP) on the value of collimator scatter factor (Sc), using 10MV X-ray delivered by linear accelerator. The source-chamber distance was fixed to be 1,000 mm. The center of MP was located in correspondence with the axis of the radiation beam. Irradiation of 400 MU was delivered with the dose rate of 400 MU/min. We measured Sc by using a combination of the 4 sizes of MPs with external diameters ranging from 10 mm to 40 mm and 11 sizes of square radiation fields ranging from 8×8 mm2 to 100×100 mm2. Consequently, the measured values of Sc were lower when the size of the radiation field was smaller than the external diameter of MP. Whether the whole volume of MP was included within the radiation field or not appeared critical for our results, and it was suggested that the differed amount of secondary electron might play a crucial role for it.

Key words: Collimator scatter factor; Narrow radiation field; Electron equilibrium
Role of Regional Alliances Section to Complete Transportation of Patient Assisted with Life Supporting System to Destination Hospital Mitsuhiko Okugawa
Sachiko Okuzaki
Miki Asari
Maoka Kojima
Kumiko Kouda
Regional alliances section introduces and receives patients reciprocally among medical institutions inside/outside Aomori prefecture. The number reaches around 4,000 per year, which includes 80 transported by doctor helicopter or ambulance of high standard. We herein reported a patient who was successfully transported to the destination hospital by using the doctor helicopter assisted with life supporting system. In this case, it was critical for safely completing the transportation that our section acted as a center of interinstitutional collaboration, carried out the detailed simulation before the actual transportation, and shared the important information among the related institutions and staffs.

Key words: Life supporting system, Transportation to destination hospital, Regional alliances

Activity Report of the Committee for Collaboration between Nursing and Caring in Mutsu, Shimokita Area:
Focusing on Creating a Network of the Bridging Windows
Kumiko Kouda
The Japanese government has been promoting home care for 2025. The Committee for Collaboration between Nursing and Caring in Mutsu, Shimokita Area was established in 2003, and installed 66 windows in its network where face-to-face contacts are available. Through this activity, we have provided people with problem solutions and professional expertise in order to achieve a seamless process in transferring a patient from a medical institution to a community. We believe it is necessary that nurses in our hospital continue being leaders of transmitting information actively to the community.

Key words: seamless, network, face to face

"Issues to be resolved for the approach to visiting nursing " with viewpoint of preventive medicine Mai Nihonyanagi
There is no end to the examples that home care patients have to be hospitalized due to decubitus and/or worsening of their general condition, although home healthcare has been promoted as one of the resolutions of medical issues in modern society. As an approach to promote visiting nurses from the viewpoint of preventive medicine, the active promotion toward care managers is thought to be necessary. Therefore, the author performed an inventory survey of 19 medical staffs working in a home nursing station. They answered that there is a need to publicize the role and the specialty of visiting nurses at home and the target should be nurses (100%), medical doctors (92%), home healthcare companies (92%) and local inhabitants (83%). As for the method of publicity, they recommended "advertisement in supermarkets or taxis”, "word of mouth communication from patients and the families", "presentation in workshops on multi-disciplinary collaboration" and so on. The current study did not show the necessity of active promotion of specialty care managers. However, to further introduce early intervention of visiting nurses from the viewpoint of preventive medicine, it is necessary for visiting nurses themselves to publicize the importance of their role to care managers as well as medical doctors, nurses and all local inhabitants.

Key words: Early intervention of visiting nursing, Viewpoint of preventive medicine, Promotion of visiting nurses
Perfomance Report
"Report of Performance of Nursing Department in The 2015 Fiscal Year " Satomi Shirahama
In the nursing department of Mutsu General Hospital, we have practiced target management. However, goal setting has tended to be qualitative, which is an issue for us because of the difficulty to estimate the value. Therefore, since the 2015 fiscal year the balanced score card has been introduced as a tool of management. As a result, the target has become quantitative, which allowed for clear estimation.

Key words: Target management, SWOT analysis, BSC, Numerical goal

The role of the clinical engineering department in this hospital Kouko Fukushima
Yukie Kumagai
Saori Sasaki
We reported on the business statistics of the clinical engineering department in the 2015 fiscal year. As for device management, the business such as inspection of pumps has remained almost same as before. The business for cardiovascular disease has remained without significant changes. With regard to the business of hemocatharsis, there was an increased tendency of treatment requests for non-hemodialysis.

Key words: Clinical Engineering department, Equipment management, Hemocatharsis

Performance Status of Duties According to Modalities in Center of Radiology/Radiotherapy in Mutsu General Hospital Hirofumi Yamagami
Masashi Muraki
Mitsuaki Kubota
Takayuki Yonenuma
Kazutsugu Kawamura
Ryuji Yoneta
Kazunori Takeo
Kohei Hamada
Takeru Kimura
Keisuke Jin
Miyako Kimura
Mei Takebayashi
Keisuke Araki
Ryota Nihonyanagi
Yasushi Mariya
We investigated the performance status of duties in the center of Radiology/Radiotherapy in Mutsu General Hospital according to the radio-diagnostic /-therapeutic modalities. Based on the current results, we are trying to improve the performance and efficiency to contribute to the benefit and profit of both our center and the hospital.

Key words: Modality, Business situation, Radiodiagnosis, Radiotherapy

Report of FY 2015 Activity Results of Department of Pharmacy, Mutsu General Hospital Masato Nishikawa
Chizuru Takahashi
Kiyoko Fujisawa
Although there is a shortage of staff, we have tried to reconsider and reduce various procedures employed so far, to expand inversely and reconstruct the content of duties which should be included as updated works by modern “hospital pharmacists”. We believe that such are necessary in contributing to appropriate and safe drug treatment for patients. Especially, we have reconsidered and adjusted the procedures of handling anti-cancer injection drugs given to cancer patients, and have stuck stickers of the injection drugs on the pages of the medicine pocket diary of the patients. For hospitalized patients, we have aggressively tried drug administration guidance and subsequently the number of guidance has increased. Further, we have participated in team medical treatment as one of our specialties. In the current report, we demonstrate our activities in FY 2015 with statistics and an estimation of the results.

Key words: Drug management instruction, Chemotherapy, Bringing medicine

FY 2015 Annual Performance Report of Department of Nutritional Management Ayumi Sawada
Nozomi Hachinohe
Saeko Suzuki
Ikuko Takano
Yoko Kitakami
Nozomi Nishii
Hanako Matsumoto
Management of meal/nourishment of patients is an important part of treatment. Administrative dietitians and regular dieticians deal with duties as specialists of nutrition for patients. Our daily works are broadly classified into meal management and nourishment management. Here we will introduce the details of our works and report the annual performance of our department in the 2015 fiscal year, composed of instruction and management of meal/nourishment. From our results, it was suggested that the future issue of our department would be to quickly intervene the nutritional disorder of patients.

Key words: Admission meal medical expenses, Nutrition diet guidance, Malnutrition

Outline of Department of Rehabilitation and Results and Clinical Indicators regarding FY 2015 Annual Performance Mitsuaki Sohma
The main part of performance of the department of rehabilitation in the 2015 fiscal year and the clinical indicators of the performance were reported. The number of inpatients who received rehabilitation therapy was almost the same as in the 2014 fiscal year when the number reached a peak. Also the number of outpatients who received rehabilitation therapy was almost the same as in the 2014 fiscal year. On the other hand, the number of patients who received cancer rehabilitation which started in earnest in the 2015 fiscal year was large. The patients were introduced from the department of internal medicine of digestive organs, that of circulatory organ, department pf surgery, and department of urology, and the numbers were the largest to date, respectively. Although the values of Functional Independence Measure (FIM) and Barthel Index (BI) remained high, the influence from the period of hospitalization should be closely examined. In the Shimokita area, having a scarcity of collaborative medical institutions, it is necessary to further construct routes for the patients to go back from an acute care hospital to their homes.

Key words: Facilities standard, Functional Independence Measure, Barthel Index, Home discharge, Liaison critical pathway

FY 2015 Performance Report of Department of Anatomical Pathology and Laboratory Medicine Fusae Narita
Performance of duties in the 2015 fiscal year in the Department of Anatomical Pathology and Laboratory Medicine of Mutsu General Hospital was reported. Every day we work hard in conformity with the idea of our department, "We always make an effort to carry out medical practice according to the necessity of each patient, to provide correct data quickly, and to obtain new techniques and a higher level of knowledge ". Also we work on clinical support as a member of the medical care team.

Key words: Performance report, 24-hour system, Clinical support

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