MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation.

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

[A study of factors influencing determination of discharge disposition of stroke rehabilitation patients].

PURPOSE: The purpose of this study is to statistically analyze medical and socioeconomic factors which influence discharge disposition from a stroke unit. METHODS: We investigated 126 stroke patients admitted to a community hospital within 30 days from the onset of the stroke. Mean age was 65.9 +/- 13.9 (SD) years old, profile of diagnosis was 89 infarctions was 37 hemorrhages, and mean length of stay was 79.7 +/- 45.1 days. Our rehabilitation team consists of doctors, nurses, physical therapists, occupational therapists and a medical social worker. Our stroke unit accepted the stroke patients from the time of admission and attempted to begin rehabilitation as soon as possible. The patients and their families were informed about their options after discharge from the hospital. Eight factors were analyzed using a multiple logistic regression model. RESULTS: 1) Ninety-eight patients (77.8%) could return home (home group) and 28 patients (22.2%) were discharged to another hospital or a long-term care facility (LTCF group). 2) Mean age of LTCF group (70.3 +/- 12.0) was significantly higher than the home group (64.8 +/- 14.2, p < 0.05). The home group showed milder leg paresis (p < 0.01), better Barthel index (p < 0.01), a higher number of family members (p < 0.05), and a better substantial care ability (p < 0.01) than LTCF group. 3) Three factors, higher Barthel index (odds ratio: 1.36), higher number of family members (1.84), and better substantial care ability (1.94), were found to facilitate discharge to home. Two other factors, hemorrhage (0.39) and public assistance (0.04), adversely affected the likelihood of discharge to home. CONCLUSIONS: This study suggests that a stroke unit could accelerate discharge home by improving the Barthel index. In addition, socioeconomic factors should be taken into consideration.

[Present situation of medical care for foreigners at medical facilities in Chiba City].

OBJECTIVE: The number of foreigners residing in Japan has increased during the past decade. The aim of this survey was to clarify the present situation and the disadvantages in the medical care for foreigners. METHODS: In October 1997, we mailed a questionnaire to all clinics and hospitals in Chiba City. The questionnaire included questions regarding the number of foreign patients who visited during the past three months, the proportion of patients who have any health insurance, procedures for handling foreign patients, and the disadvantages in medical care for them. RESULTS: Of the 210 respondents (183 clinics and 27 hospitals), 133 facilities (63.3%) provided medical care for foreign patients during the past three months, and 187 (89.0%) during the past year. In 102 facilities (76.7%), the number of foreign patients was fewer than 10 during the past three months. The mean number of foreign patients was 13.8 per facility (12.2 per clinic, and 23.5 per hospital). Of these foreign patients, 68.6% had any health insurance. In 172 facilities (81.9%), foreign patients were accepted in the same way as the Japanese. The main disadvantages in medical care for foreigners were difficulty in understanding because of communication problems, and default in payment of medical expenses for the foreigners with no health insurance. In 154 facilities (73.3%), no special preparation to communicate with foreign patients was provided, and few facilities could understand foreign languages except for English. In 20 facilities, fees for medical care had been left unpaid by foreign patients during the past year, and the total outstanding amount was about 23,800,000 yen. CONCLUSION: In Chiba City, many medical facilities provide medical care for foreign patients. This study suggests that support for communication with foreigners and compensation for default in medical expenses are necessary.

[An assessment of the thalamocortical sensory pathway based on small infarcts in the corona radiata on CT].

Although lacunar syndrome is relatively commonly encountered in patients with a lacunar infarct in the deep cerebral white matter, the responsible lesions are often unidentified. By examining eight patients with lacunar syndrome who had small infarcts in the deep cerebral white matter, an attempt was made to determine the position and distribution of the sensory pathway on brain CT at the level of the splenium of the corpus callosum. When the distance from the frontal crista to the superior saggital sinus sulcus was defined as 1.0, the position of the corticospinal tract was located in the portion from 0.45 to 0.49 and that of the sensory pathway in the portion from 0.49 to 0.53. These data indicated that the position of the sensory pathway was just behind the corticospinal tract and the distribution was very narrow at this level. The results of this assessment revealed that lacunar infarcts in the deep cerebral white matter were liable to cause sensorimoter syndrome more than pure sensory stroke.

Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables.

OBJECTIVE: To determine if the spread of Clostridium difficile-associated diarrhea is related to the use of electronic thermometers in an acute hospital and a chronic healthcare facility. DESIGN: After finding that a significant percentage (20.8%) of electronic rectal thermometer handles were contaminated with C difficile, all electronic thermometers were replaced with disposables. A before/after trial was conducted to determine if the change to disposable thermometers would reduce the incidence of C difficile-associated diarrhea. SETTING: The study took place in a 343-bed acute hospital and a 538-bed skilled nursing facility. PATIENTS: All patients who underwent routine microbiological evaluation for nosocomially acquired diarrhea over a 1-year period were included in the study. Nosocomial diarrhea was defined as 3 or more loose stools per day for 2 consecutive days and/or abdominal findings such as pain, distension, and ileus occurring 3 or more days after admission. RESULTS: During the 6-month postintervention period, the incidence of C difficile-associated diarrhea was reduced from 2.71/1,000 patient days to 1.76/1,000 patient days in the acute hospital and from 0.41/1,000 patient days to 0.11/1,000 patient days in the skilled nursing facility. The protective effect of the intervention was statistically significant for both facilities. CONCLUSIONS: Replacement of electronic thermometers with single-use disposables significantly reduced the incidence of C difficile-associated diarrhea in both acute care and skilled nursing care facilities. Data suggest that the rectal route may be important in the transmission of C difficile in these settings.

[Assessment of endoscopic embolization in the management of esophageal varices].

Between February 1984 and September 1987, endoscopic embolization (EE) was performed in 26 patients with esophageal varices. The effects of EE were evaluated with endoscopic findings according to the general rules for recording endoscopic findings on esophageal varices as specified by the Japanese Research Society for Portal Hypertension. 1) When the result was regarded as effective if a patient had Cw, F1, R-C sign (-), Li and Lm or disappearance of varices, the improvement was found in 66.7% for Color, 79.2% for R-C sign, 54.2% for Form and 45.8% for Location after EE. 2) Recurrence of varices was found in 50% of the patients (12/24) and 4 of 12 cases (33.3%) had rebleeding. 3) When the endoscopic findings before and after EE were compared between relapsed and unrelapsed cases, relapsed patients had more unfavorable endoscopic findings, furthermore, the extent of improvements was also worse than that of unrelapsed cases. 4) As complications, slight fever, dysphagia and epigastric pain were found in most cases, however, all were cured conservatively. In conclusion, EE is useful and safety tool for the improvement of endoscopic findings of the patients with esophageal varices.