Medical statistics need to be properly understood and used in order to assess the significance of results obtained in clinical practice. To clarify whether the medical staff in our hospital appropriately understands medical statistics, this study conducted a questionnaire survey with an objective assessment of basic medical statistics. Of 1498 hospital staff, 464 responded to the questionnaire on medical statistics, which included the following items considered important for the evaluation and use of hypothesis testing: interpretation of p-values, reasons for using different tests (t-test and Mann-Whitney U-tests), presentation of test results for the Mann-Whitney's U-test, and selection of a statistical method to use as a measure of independence. The percentage of correct answers was 20.5%, 16.2%, 6.3%, and 15.1% for the interpretation of p-values, reasons for using different tests, presentation of test results, and choice of statistical method, respectively. The percentage of correct answers for each question was significantly higher for those with research and writing experience than for those without such experience. The number of correct answers was also significantly higher for those with research and writing experience than for those without such experience. Additionally, 20 of the 464 respondents were able to correctly answer all four questions. Multiple regression analysis showed that the number of correct answers was associated with experience in research, experience in writing papers, and job title (multiple regression analysis: R²=0.429758). Our medical staff’s understanding of medical statistics was low, and we were able to identify some of the factors that influence this understanding. These results suggest the importance of learning from clinical research and writing experience in order to improve understanding of medical statistics in the future.

View full abstract

　Community-based care systems aim to enable people to live to the end of their lives in the community. Hospitals for community-based care, established in 2014, often provide dementia care with the aim of helping patients return to their own lives. For this reason, nursing professionals working in these hospitals are required to cultivate ethical standards and improve their care skills. The objective of this study was to investigate the moral sensitivity of nursing professionals working in hospitals for community-based care, as well as their knowledge of and attitudes toward dementia, and to identify associated factors. A questionnaire survey was administered to 208 nursing professionals in nine hospitals for community-based care in two prefectures, and 97 respondents were included in the analysis. The results of the analysis showed no association between moral sensitivity and knowledge of and attitudes toward dementia. There were weak associations of moral sensitivity with total years of work experience and whether or not the nurses had attended training courses on dementia nursing. Data also revealed that those with a “higher awareness of dignity” might also have a higher awareness of “helping patients live their own lives” and of “making the most of the abilities of the elderly”. Our results suggest that improving moral sensitivity requires training on dementia and ethics, ongoing ethics conferences, and creation of an environment that encourages awareness of ethics.

View full abstract

　Surrogate decision-making support in the critical care field is a highly challenging form of support owing to its urgency and the fact that families are in crisis situations. Given this context, the diversification of families as a feature of modern society is thought to bring further difficulties to nurses who are involved in surrogate decision-making support. Therefore, this study sought to clarify the content of such support for diverse families that skilled nurses provided in the critical care field. We conducted semi-structured interviews with nine skilled nurses and a qualitative and inductive analysis of the obtained data. We extracted the following five categories of surrogate decision-making support. Even when there was no spare time in the critical care field, skilled nurses operated on the premise that family relationships and values are diverse while (1) “creating a foundation for surrogate decision-making that satisfied families” and (2) “making decisions based on a broad view of family relationships without being bound by preconceptions”, and they realized individualized support by (3) “adjusting the role of surrogate decision-makers based on family characteristics”. In cases where responses were difficult, it became clear that support was provided while (4) “responding to families in accordance with social norms” and demonstrating the ability to (5) “involve medical teams and finds solutions in difficult cases”.[[Please check that this conveys your intended meaning]]

View full abstract

　There have been no reports of disuse syndrome in pregnant women due to hyperemesis gravidarum. In this report, we describe a case of prolonged severe hyperemesis gravidarum that resulted in disuse syndrome and required long-term rehabilitation. The patient was 28-year-old woman in her first pregnancy. She was admitted to another hospital for hyperemesis gravidarum at 9 weeks' gestation, but her symptoms did not improve and she was transferred to our hospital at 13 weeks' gestation. Central venous nutrition was started for hypofunction, and rehabilitation was initiated based on a diagnosis of disuse syndrome with marked muscle weakness caused by bed rest and immobility. Her activities of daily living gradually improved and her oral intake increased, so she was discharged home at 27 weeks' gestation. She gave birth to a baby weighing 2856 g via vaginal delivery at 38 weeks and 5 days of gestation. This case demonstrates that hyperemesis gravidarum can result in disuse syndrome due to decreased activity. In addition, undernutrition is negatively correlated with the effectiveness of rehabilitation. Thus, nutritional management is important not only for the treatment of hyperemesis gravidarum, but also for the prevention of disuse syndrome and effective rehabilitation.

View full abstract

　There is no evidence for effects of gait training in spinocerebellar degeneration (SCD) of SCD severity level IV. Here we report the effect of gait training in a 42-year-old man diagnosed with SCD severity level IV. At the beginning of physical therapy (day X), his Scale for Assessment and Rating of Ataxia (SARA) score was 20 and his Berg Balance Scale (BBS) score was 27. The patient required two people to assist him in walking because of his high risk of falling due to ataxia, which caused the lower limbs to step out in unexpected directions. His Functional Ambulation Categories (FAC) score was 0. Regular standing and balance function exercises failed to improve his condition, and he was switched to physical therapy focusing on gait training using a walker with a saddle (OG Giken Safety Walker GB-500), which improved his SARA score to 15 and BBS score to 35 at day X+24. He became able to walk with the assistance of one person, and with the use of handrails, his 10 m walking speed was 12 s and his continuous walking distance was 60 m. His FAC score also improved to 2, and he was transferred to another hospital to continue his rehabilitation. Even in this patient with SCD severity level IV, intensive gait training using a walker with saddle resulted in improved walking ability.

View full abstract

　In infectious enteritis, the affected site differs depending on the organism causing the disease, and based on this feature, it is possible to estimate the causative organisms of infectious enteritis. However, there have been few reports of infectious enteritis mainly affecting the duodenum. This report describes a case of duodenal enteritis that was suspected to be associated with Legionella infection. The patient was a 66-year-old man. He was febrile for 5 days and had watery diarrhea for 3 days before admission, and he presented to our hospital when the symptoms did not improve. He was hypoxemic at presentation, and a CT scan on admission revealed nonsegmental ground-glass opacities in both lung fields and thickening of the intestinal wall, mainly in the duodenum. Blood tests and chest imaging findings led to suspicion of Legionella pneumonia. Urine specimens were submitted for Legionella antigen testing and were found to be positive, confirming the diagnosis. Subsequent antimicrobial therapy resulted in improvement of the diarrhea symptoms and duodenal wall thickening, and the patient was discharged on hospital day 19. This case shows that Legionella pneumonia can manifest as abdominal symptoms. The possibility of Legionella pneumonia should thus be considered in patients with duodenitis.

View full abstract