Analysis of factors contributing to medication errors during self-management of medication in the rehabilitation ward: a case control study.

BACKGROUND: In the rehabilitation ward, many elderly patients require continuous use of medication after a stroke or bone fracture, even after discharge. They are encouraged to self-manage their medications from the time of admission. Medication errors, such as a missed dose or incorrect administered medication can worsen conditions, resulting in recurrent strokes, fractures, or adverse effects. The study was aimed to identify risk factors, such as medication and prescription, contributing to errors in self-management of medication. METHODS: This study was conducted on patients who self-managed their medication in the rehabilitation ward of Higashinagoya National Hospital from April 2018 to March 2020. The patient background including age and sex were investigated. The medication factors examined include the number of medications and administrations per day, dosing frequency on indicated days, prescription and start date are the same, medications from multiple prescriptions, and one package or one tablet at each dosage. The group of medication error cases were defined as the medication error group and that of control cases as the no-medication error group. A logistic regression analysis was performed for factors related to medication errors. RESULTS: A total of 348 patients were included in the study, of which 154 patients made medication errors, with 374 total medication error cases. The median number of medications in the medication error group was six, and that in the no-medication error group was five. Statistically significant factors correlated with errors made during self-management of medication were the number of medications, number of administrations per day, dosing frequency on indicated days, and medication from multiple prescriptions. CONCLUSIONS: When a patient is self-managing their medications, errors are likely to occur due to a high number of medicines they are taking and the complexity of the dosage regimen. Therefore, to prevent medication errors, reviewing the prescribed medications and devise ways to simplify the dosage regimens is crucial.

Cow's Milk Allergy with Severe Eosinophilia.

Because the role of eosinophils in neonates is not well understood, the clinical significance of eosinophilia in neonates is unclear. We encountered a rare case of cow's milk allergy in a premature male infant with severe eosinophilia in the neonatal period. The peripheral blood eosinophil count in this infant was 7,404/µL at birth, and he produced stools with fresh blood immediately after birth and prior to the first feedings with regular cow's milk. Although the patient's eosinophil count normalized without specific treatment within 6 weeks after birth, it is possible that the causes of the eosinophilia in this infant prior to the first feedings with regular cow's milk were different from those after the first feedings. Cow's milk allergy was diagnosed on the basis of the patient's positivity for this allergy in the challenge test and subsequent allergen-specific lymphocyte stimulation test performed at 6 months of age.

Neurodevelopmental outcomes of children with periventricular leukomalacia.

OBJECTIVES: To examine the neurodevelopmental outcomes of children with periventricular leukomalacia (PVL). MATERIALS AND METHODS: Twenty-five children diagnosed with grade 1, 2 or 3 PVL on the basis of magnetic resonance imaging (MRI) findings between January 2002 and December 2011 were enrolled and followed from 15 months to 10 years of age. RESULTS: Of the 25 children, one was a term and 24 were preterm-births. Nine (36%) had spastic diplegia and 12 (48%) had quadriplegia. Ten of the 25 (40%) were able to walk independently at 36 months utilizing short leg braces, whereas 13 children (52%) were unable to walk independently. MRI findings revealed grade 1 PVL in nine (36%), grade 2 in 12 (48%), and grade 3 in four (16%) of the 25 children. Eleven of the 16 children (69%) with grade 2 or 3 PVL had Papile III or IV intraventricular hemorrhage (IVH), and many of these children had severe neurologic motor abnormalities, severe psychomotor delay, and seizures. Five of the nine children (56%) with grade 1 PVL had normal psychomotor development. There were statistically significant differences in the motor impairment and walking ability between the children with grade 1 and those with grade 2 PVL (p = 0.008 and 0.005, respectively). CONCLUSION: Most children with grade 2 or 3 PVL had severe neurodevelopmental delays, but attention should also be paid to the 56% of children with grade 1 PVL who presented with normal psychomotor development. Further studies of larger populations, including long-term follow-up, are necessary to evaluate the outcomes of children with PVL.

Nurses' recognition of the mental state of cancer patients and their own stress management - a study of Japanese cancer-care nurses.

OBJECTIVE: The primary aim of this study was to describe Japanese oncology nurses' self-reported ability to assess and care for cancer patients' mental health. A secondary aim was to describe nurses' self-reported stress levels and need for stress management related to caring for oncology patients. METHODS: This cross-sectional questionnaire study was conducted from September to November 2010 among cancer-care nurses participating in mental healthcare training. The questionnaire asked about assessment of patient anxiety, depression, delirium, anger, and acceptance, and included four statements about work-related stress. A 4-point Likert scale was used for responses. RESULTS: The 88 participants (86 women) ranged in age from the 20s to the 50s, with the greatest number in their 30s (47.2%, n=42). More than 50% of nurses were very concerned about assessing cancer patient anxiety and depression; approximately 20% were extremely concerned about caring for depression and anger in patients. Overall, 83.2% (n=74) of cancer-care nurses felt distressed over their occupation, only 19.1% (n=17) stated that they were controlling their stress, and over half indicated a need for stress-management programs. CONCLUSIONS: Nurses perceived that assessments of and care for the mental state of cancer patients were inadequate. Cancer-care nurses need training in assessing and caring for the mental state of cancer patients, as well as stress management training programs for themselves.

Outcome of fetal echocardiography: a 17 year single-institution experience in Japan.

BACKGROUND: The aim of this retrospective study was to evaluate the influence of prenatal diagnosis on perinatal outcomes of congenital heart disease (CHD) over a 17 year period at a single center. METHODS: The perinatal outcome of CHD in 146 patients diagnosed on fetal echocardiography between 1994 and 2010 were reviewed. The characteristics of 193 neonatal inpatients with CHD treated at the authors' department between 2001 and 2010 were also analyzed; among the inpatients, 61 were diagnosed before birth (prenatal group) and 132 were diagnosed after birth (postnatal group). RESULTS: Among the 146 patients prenatally diagnosed with CHD, the prenatal mortality, including abortion and stillbirth, decreased from 1994 to 2010. Among the 193 neonatal inpatients, the prenatal group had lower gestational age and bodyweight than the postnatal group. Further, the prenatal group had lower blood pH at admission, but no patient in that group experienced ductal shock, although six patients in the postnatal group did. The average dose of prostaglandin E1 used in duct-dependent CHD was significantly lower in the prenatal group than in the postnatal group (3.4 vs. 4.6 ng/kg per min; P = 0.015). CONCLUSIONS: Prenatal diagnosis of CHD enables planned labor, prevents ductal shock, and reduces prostaglandin E1 side-effects and medical expenditure.

A case of cor triatriatum with an abnormal P wave: the pacemaker action from the specialized tissue in the abnormal septum.

A boy presented with an abnormal P wave shown on an electrocardiogram (ECG) checkup at school. An echocardiogram and contrast-enhanced computed tomography (CT) showed cor triatriatum with a slit-like opening between the accessory chamber and the left atrium located along the interatrial septum. The boy underwent open heart surgery for excision of the anomalous membrane, and a postoperative ECG showed normal P waves. The excised tissue was examined immnunohistopathologically using antihyperpolarization-activated cyclic nucleotide-gated potassium channel 4 (HCN4) antibody and other staining. The authors confirmed the existence of cells positive to HCN4, indicating that they were sinoatrial node cells or at least cells with electrical automaticity.

A case of Henoch-Schoenlein purpura nephritis recurring after 3 years remission.

Henoch-Schoenlein purpura (HSP) is a systemic disorder characterized by leukocytoclastic vasculitis involving the capillaries with IgA immune complexes deposition, and about 7% of patients with HSP experience recurrence. Most patients with recurring of HSP nephritis show a recurrence of clinical symptoms over a period ranging from 2 to 5 months, even after the disappearance of initial symptoms. Here we report a 9-year-old girl diagnosed with recurrent HSP and severe crescentic glomerulonephritis 3 years after complete resolution of the initial symptoms of HSP. Our case is unique in respect of the recurrence at more than 3 years after the complete resolution of initial symptoms, suggesting that careful followup is required in spite of improved renal symptoms in cases of HSP.

A 10-year-old girl with IgA nephropathy who 5 years later developed the characteristic features of Henoch-Schönlein purpura nephritis.

We report a patient who developed Henoch-Schönlein purpura (HSP) 5 years after she presented with immunoglobulin A nephropathy (IgAN). A 10-year-old Japanese female was identified with proteinuria and hematuria by a school urinary screening. The first renal biopsy showed mesangial proliferative glomerulonephritis with immunofluorescent findings consistent with IgAN. She was treated with prednisolone, warfarin, and dilazep dihydrochloride, and the proteinuria and hematuria disappeared 4 months after the onset of treatment. Five years later she developed abdominal pain, gross hematuria and a classic purpuric rash of HSP after acute pharyngitis. The second renal biopsy showed diffuse mesangial proliferation with cellular crescent formation, and the patient was treated with methylprednisolone pulse therapy, prednisolone and mizoribine, resulting in a gradual decrease in urinary protein excretion. Our patient is unusual in that she developed Henoch-Schönlein purpura nephritis 5 years after clinical and biopsy evidence of IgAN, which suggests that IgAN and HSP are different clinical manifestations of the same disease, probably sharing a common pathogenesis.

Relationship between decreasing fertility during the post-war period and maternal age in a Japanese population.

This research was performed in an effort to understand the decrease in fertility that has occurred over the past few decades. The objective of the study was to analyze female fertility according to maternal age; data were based on the number of children born per mother. The records of 18-year-old college students were obtained, and the mothers of the students were categorized into age groups according to the year of their birth (1915 to 1949). The number of children born to each mother was then analyzed. The total sample size was 4078. The results showed that an increase in two-children families led to a reduction in the mean number of children per mother. While the decrease in the maternal age at the time of the birth of the last child in the family was observed, the maternal age at the time of the first birth did not increase. Thus, the reduction in fertility may not be the result of delayed motherhood. The group of mothers, who gave birth to the largest number of children, had their highest fertility rate in the twenties. In addition, their fertility rate in the thirties was almost equal to other groups, who had the same fertility level in their twenties.