Post-Fukushima radiation education for public health nursing students: a case study.

BACKGROUND: The recent Fukushima Nuclear Power Plant accident was one of more than 200 serious nuclear/radiation incidents (accidents and disasters) that occurred worldwide since 1945. The current Fukushima disaster is in the recovery phase with the decreasing levels of radiation in the environment. However, fears and stigma related to the perceived risk of radiation exposure persist among the general population. INTRODUCTION: To improve on students' preparedness for social and public health challenges after a radiation incidence, radiation education was provided for undergraduate public health nursing students. AIM: This case study reports the development and implementation of the first class of radiation education in public health nursing, as well as students' reflections on their class experience. METHODS: We included a 90-min radiation class in an undergraduate public health nursing course in Tokyo, Japan. Lectures/discussion on technical and environmental aspects provided the minimally essential content for basic radiation knowledge. After class, all the 65 students were invited to freely write their reflections on the class. With their consent, 61 students' anonymous written accounts were qualitatively analysed. RESULTS: Five themes emerged: awareness of ignorance about radiation, problems produced by the mass media, becoming knowledgeable about radiation, public health nurses' role, and trustful and enjoyable lecture. DISCUSSION: The class inspired students to consider social, psychological and relational aspects of knowing and not knowing about radiation and their future professional role. CONCLUSION AND IMPLICATIONS FOR NURSING: Once radiation is taught at school, nursing students will emerge as professionals with the belief that radiation is within their professional purview. Education is key to disaster prevention, preparation, response and recovery. Given the ubiquitous nature of health challenges after a radiation incident, radiation education is indispensable for nursing students worldwide.

Causes of failure of a barcode-based pretransfusion check at the bedside: experience in a university hospital.

SUMMARY: The objective of this study was to assess the cause of failure of bedside barcode identification before blood administration. The bedside check is the most critical step for prevention of mistransfusion. A barcode patient-blood unit identification system was implemented in all inpatient wards, operating rooms and an outpatient haematology unit in July 2002. The transfusion service monitored compliance with bedside barcode identification and checked it at 24 h or 1 h after issuing of blood. If electronic checking was not completed at that time, the transfusion service clarified the cause of failure and indicated the immediate use of the issued blood when it was not yet transfused. From April 2004 to December 2007, a total of 43 068 blood components were transfused without a single mistransfusion and 958 transfusions (2.2%) were performed without electronic checking. The overall compliance rate with bedside barcode identification was 97.8%, and it was 99.5% in the past 6 months. The cause of failure of bedside barcode identification was human error in 811 cases (84.7%), handheld device error in 74 (7.7%), system error in 50 (5.2%) and wristband error in 23 (2.4%). The number of errors leading to failure of bedside barcode identification was decreased for human errors, especially manipulation errors, after initiation of notification at 1 h after issuing of blood. The transfusion service may have an important role in increasing transfusion safety by monitoring compliance with bedside verification and bedside use of issued blood.

Electrophysiological investigation of hemifacial spasm after microvascular decompression: F waves of the facial muscles, blink reflexes, and abnormal muscle responses.

In patients with hemifacial spasm, it has been said that the spasm is due to cross compression of the facial nerve by a blood vessel and that microvascular decompression (MVD) of the facial nerve is an effective treatment. The F waves, which result from backfiring of antidromically activated motor neurons of the facial motor nucleus, are indices of the excitability of the facial motor nucleus and are enhanced in patients with hemifacial spasm. Measuring blink reflexes and abnormal muscle responses (lateral spread), a characteristic sign of hemifacial spasm, has been used to investigate the mechanism of hemifacial spasm pathophysiologically. Thus the authors measured F waves of the facial muscle, blink reflexes, and abnormal muscle responses before and after MVD in patients suffering from hemifacial spasm to investigate the excitability of the facial motor nucleus and the course of the cure of hemifacial spasm after MVD. The authors obtained facial nerve-evoked electromyograms in 20 patients with hemifacial spasm before and after the MVD procedure. On the spasm side, the F waves and blink reflexes were enhanced preoperatively compared to those on the normal side and abnormal muscle responses were recorded in all patients. In 12 patients whose hemifacial spasm had not disappeared completely for 5.1 +/- 1.7 (mean +/- standard error) months following the MVD procedure, F waves were still enhanced significantly and abnormal muscle responses were still recordable, albeit at lower amplitude. Within 1 month after the hemifacial spasm had disappeared completely. F waves were still significantly enhanced in 17 patients and abnormal muscle responses were recorded in seven of 15 patients. Subsequently, the enhanced F waves and abnormal muscle responses disappeared completely. The authors' study supports the hypothesis that the cause of hemifacial spasm is hyperexcitability of the facial motor nucleus and suggests that additional surgery should not be performed for at least 2 years after MVD, because that period is necessary for the disappearance of the hyperexcitability of the facial motor nucleus.

Trauma center closure: effects on an adjacent trauma center.

The effects of the closure of a busy trauma center on an adjacent university trauma hospital were analyzed. Significant increases were found in monthly volume (P less than .01) and frequency of penetrating injuries (P less than .05) and significant decreases in patients with insurance coverage (P less than .01) and numbers requiring intensive care (P less than .01). The authors conclude that trauma center closures have significant and measurable effects which influence allocation of scarce resources within remaining hospitals and generate pressures to transfer patients to overburdened public facilities. Transfers undermine continuity of care and education and further threaten the integrity of the trauma system.

Recent trends in viral hepatitis among Japanese children.

The prevalence of viral hepatitis in Japan were very high as peak HBsAg positive rate of 2-3% and HBsAb positive rate of 25% of peoples born in the 1930th and 1940th. But recently in Japan hepatitis A has completely eradicated and hepatitis B and C were seldom seen in our pediatric clinics. Many strategies were done beginning from sterilized water service to introduction of HCV-Ab screening system for blood transfusion in 1989. Many efforts had combined to get final success. The historical views of epidemics of viral hepatitis and maneuvers to improve were introduced here.

[Transference of cefmenoxime from serum to lung tissue].

Ten patients who were performed pulmonary resection for the disease of the lung, were administered 2 g of cefmenoxime (CMX) by intravenous injection before their operation. The concentrations of CMX in serum and lung tissue were determined. The CMX concentrations in lung tissue were observed to be higher than the MIC of CMX for Klebsiella pneumoniae, Haemophilus influenzae and Serratia. These results suggested that CMX will be useful agent for the prevention and treatment of pulmonary infection.

[Serum and tissue levels of cefodizime in the pediatric patients].

We administrated cefodizime (40 mg/kg) to 13 patients with simple herniorrhaphy in the pediatric field and determined its concentrations in tissues and serums. The mean serum and tissue levels of cefodizime after administration were 43.1 +/- 13.3 micrograms/ml, and 23.1 +/- 6.4 micrograms/g, respectively, at 3 hours. Cefodizime concentrations of the tissue and serum were maintained at relatively high levels for many hours. The ratio of cefodizime concentrations in tissue to serum became high at 3 hours after administration, and this suggests that tissue concentrations decreased more slowly than serum levels, and cefodizime concentrations in tissue were maintained at fairly high levels over a long period. No side effects caused by cefodizime were observed. From pharmacokinetic and clinical observations, cefodizime appears to be a safe and effective injectable antibiotic for the treatment of infections in children.

[Fenestrated basilar artery aneurysm: case report].

The authors reported an operated case with an aneurysm arising from the proximal end of basilar artery fenestration, and discussed its etiology and surgical strategy. A 47-year-old woman presented with slight memory disturbance. Neuroradiologic examination revealed an aneurysm located on the proximal end of the basilar artery 12 x 9 mm in size at the level of the outer auditory meatus. The union of vertebral arteries had deviated toward the right side, and the aneurysmal dome had projected into the fenestration. Through the right far lateral approach, we applied two straight fenestrated clips X configuration to the aneurysm. Several authors have reported a variety of approaches for vertebrobasilar aneurysms along the midline with consideration of the height of the aneurysmal. However, another point of view is that attention should be paid to the direction of the clip blade and applied at the final clipping, because, for vertebrobasilar aneurysms adjacent to the midline, the surgical view and working space are extremely restricted.

[Support for and problems associated with the highly health care-dependent, single-living elderly].

As a result of trends toward nuclear families and fewer children, the proportion of elderly persons living alone has been increasing in recent years. While an expansion of regional welfare has been proposed, health care problems will intensify and complexity will increase wherever single-living elderly persons desiring treatment at home are highly health care-dependent. Our visiting nurse station is no exception, necessitating a careful consideration of support system preparation, as well as means to respond on an individual basis now and in the future. With the object of investigating a support system able to undertake appropriate health care at home for single-living elderly persons requiring some form of treatment, this study utilized case records at our visiting nurse station to study living conditions and support activities relating to the one-year period of 1997 for three particularly health care-dependent individuals among single-living elderly persons. In terms of health care support, the results include a proposal for convenient treatment regimens suited to activity schedules and degrees of dementia, adjustment of the number of visits based on patient status, efforts to cooperate with helpers and family and to share information, and emergency response preparation. Topics for future study include assessment methods for dementia and living capacity, and safety enhancement.

[Efficacy of lidocaine cream in protecting against thermal stress during hyperthermia].

Hyperthermia is performed in combination with chemotherapy as multimodal treatment for recurrent and advanced cancer. It is generally believed that the temperature cannot be raised higher because of thermal stress. In this study, we examined the efficacy of lidocaine cream in protecting against thermal stress during hyperthermia. We devised a new local anesthetic cream containing 5% lidocaine. The subjects were eighteen patients with stomach cancer, liver cancer, or large intestine cancer. This cream was applied locally to the skin with an occlusive dressing for about one hour before hyperthermia was performed, and was wiped away just before hyperthermia. The pain scores in the treatment group were significantly lower than in the no-treatment group (p < 0.05). The scores for sensation of heat in the treatment group were lower, though not to a significant extent, than those in the no-treatment group. No adverse effects were observed. Plasma concentrations of lidocaine were lower than 0.5 microgram/ml, and percutaneous absorption of lidocaine from the lidocaine cream was minimal.

[Rheumatoid arthritis-associated bronchiolitis successfully treated with erythromycin].

A 52-year-old man with a 4-year history of rheumatoid arthritis, and who had an episode of suspected BOOP in early 1994, was admitted to our hospital because of cough and fever. A chest X-ray film on admission showed small patchy infiltrates, and a computed tomographic (CT) scan showed centrilobular nodules and patchy infiltrates with thickened broncho-vascular bundles in both lungs. Transbronchial and thoracoscopic lung biopsies disclosed the coexistence of interstitial pneumonia with BOOP pattern, follicular bronchiolitis, and diffuse panbronchiolitis-like purulent and obliterative bronchiolitis. Due to findings of chronic sinusitis, the patient was treated with erythromycin for 8 weeks, and the abnormal CT shadows regressed. This was an interesting case of various pulmonary lesions associated with rheumatoid arthritis, and successfully treated with erythromycin.

[The efficacy and prognosis of transcatheter chemoembolization for hepatocellular carcinoma in the elderly].

Four hundred and twenty-one patients with hepatocellular carcinoma who firstly underwent transcatheter arterial chemoembolization were divided into three groups as "younger" (32-69yr-old, n = 340), "elderly" (70-79yr-old, n = 74) and "super-elderly" (80-89yr-old, n = 7). Between "younger" and "elderly," clinical stage of underlying liver disease, stage of hepatocellular carcinoma and tumor necrosis rate at first treatment did not differ significantly. In these two groups, the first year survival rates were 83.2, 79.7%, the third year survival rates were 47.2, 36.5% and the fifth year survival rates were 22.9, 14.5% respectively. Cumulative survival rate of the "elderly" was similar to the "younger". Factors significantly affecting the survival period included advanced clinical stage of underlying liver disease and hepatocellular carcinoma, poor tumor necrosis at the first treatment and high serum alpha-fetoprotein level in the "younger" and high alpha-fetoprotein, advanced stage of hepatocellular carcinoma and presence of other than liver disease in "elderly". Transarterial chemoembolization is useful for the treatment of hepatocellular carcinoma in the "elderly" with the attention for their underlying diseases.

[Gastrointestinal complications and their prevention after abdominal aortic reconstruction, especially factors and prevention of paralytic intestinal ileus after a abdominal bifurcated grafting operation].

We experienced 66 cases of abdominal aortic repair, which contained 49 cases of abdominal aortic aneurysm (AAA) and 17 cases of high leveled arteriosclerotic occlusion (high ASO), since March, 1977 till December, 1985. Operative procedures were 44 cases of Y-graft replacement and 5 cases of tube graft interposition for all of AAA, and Y bypass grafting for high ASO. As early gastrointestinal complications after these repairs, paralytic intestinal ileus was found 9 cases in AAA group and no case in high ASO group. Mechanical intestinal ileus needed surgical lysis was found one case in AAA group and one case in high ASO group, upper gastrointestinal bleeding was found 2 cases in both groups, transient ischemic colitis 4 cases in AAA group, and liver dysfunction 4 cases in AAA group. The most frequent complication was paralytic intestinal ileus. In the comparison between 9 cases of paralytic intestinal ileus and others, operative time of the former was significantly longer than that of the latter. But there were no differences in the incidence of other factors. We think that, operative procedure must be chosen in consideration of shortening the operative time. And careful management of gastrointestinal tract and pre-operative correction of general conditions, especially the correction of serum electrolytes and nutrition are the most important.

[A clinical study on asthmatic patients who were readmitted after a short period of discharge].

We conducted a clinical study on asthmatic patients who were readmitted within three months of discharge. During twelve years (1979-1991), the number of patients who were readmitted within three months was 139 cases (209 episodes) in our department. Patients with respiratory diseases made up 53% of the subjects. Among patients with pulmonary disease who were readmitted within three months, the number of patients with lung cancer was 25 cases and that with bronchial asthma 24 cases. Within a month period, the number of readmitted patients with bronchial asthma was the largest 59% (19 cases) and the number of patients with lung cancer came second (4 cases). As for the characteristics of these asthmatic patients, the intrinsic type (15 cases), those with a history of over one year of the disease (20 cases), and those with steroid dependency (10 cases) were most commonly observed. Readmission occurred frequently between October and April. Readmission occurred frequently because of asthmatic attacks due to infection of reduction of steroid. Among asthmatic patients who were readmitted within one month, the disease severity was mild to moderate in 11 out of 19 patients, but there was a tendency for this to become intractable thereafter. It is impossible to prevent all patients from seeling readmission within a short period of discharge. However, we think the doctor's careful education of the patients is an important factor to reduce the early readmission rate of asthmatic patients.