A case of eosinophilic chronic rhinosinusitis associated with optic neuropathy

We report a case of eosinophilic chronic rhinosinusitis (ECRS) associated with optic neuropathy. The visual acuity in the right eye was suddenly reduced to no light perception on awakening in the morning. Fundus examination of both eyes on the same day showed no remarkable changes. Emergency computed tomography showed pan-sinusitis bilaterally and a partial defect of the sphenoid bone on the right side. From the clinical findings, the case was diagnosed as optic neuropathy associated with chronic sinusitis. Endoscopic sinus surgery (ESS) was performed on the same day, and all of the major sinuses were found to be filled with highly viscous fluid. Part of the optic canal had a defect probably due to inflammatory invasion from the adjacent sphenoid bone. Steroid therapy was started immediately postoperatively. Histopathological examination of excised polyps showed that numerous eosinophils had invaded the polyps but no hyphae were present. The patient reported that he had bronchial asthma and had had nasal polypectomy. Six months after the ESS and steroid therapy, the patient had a recurrence of the sinusitis. At that time, laboratory examination showed an elevation of total IgE and eosinophil numbers. From the clinical findings and course, this case was diagnosed as ECRS accompanied by optic neuropathy. Although ECRS rarely has ocular complications, the inflammation can spread and the optic nerve can be affected

「健康教室」に関する学内演習と地域看護学実習での学生の学びと学習の成果

現在の社会では、生活様式の変化に伴って引き起こされた生活習慣病を予防することが大きな課題となり、個人が生活習慣を改善するための行動変容が求められ、そのきっかけのひとつの手段として「健康教室」などが地域保健従事者には求められてきている。これらの背景を踏まえ、看護2年次の授業で学生同士による健康教室演習を体験させ、看護3年次の実習では地域住民を対象に住民の健康問題を踏まえた「健康教室」を実施させている。そこで、看護2年次に行う「健康教室演習」が看護3年次の地域看護学実習中に行う健康教室実習にどのように反映されているのか。また健康教室実習での学びを明らかにすることを目的とした。その結果、演習と実習の評価得点ついては「対象者の反応が確認できた」、「時間配分の適切さ」、「参加者の安全の確保」に有意な差がみられた。また、健康教室実習では「健康教室の意義」や「指導の難しさ」などについての学びが明らかになった。今後、演習と実習を連動させることにより、学生が効果的な健康教室の実践が出来るような教育的指導の必要性が示唆された。Today, as the prevention of adult diseases attributable to changes in lifestyle has become a major challenge, behavioral modification for individuals to improve their lifestyle is increasingly needed, and community health workers are required to practice such measures as part of a "health workshop" to motivate people to do so. In this context, we provide second-grade students with an opportunity to experience health workshop practice in the classroom, and third-grade students conduct health workshops with residents in the community in view of their health problems. Thus, this study was conducted to clarify how the classroom practice was reflected in the health workshop during nursing practice, and what students learned from the health workshop in the nursing practice. The results revealed that evaluation scores for the classroom practice and the nursing practice significantly differed in the items "the audience\u27s responses were clear," "appropriateness of time allocation," and "securing of participants\u27 safety." It was also demonstrated that students had learned the "significance of the health workshop" as well as the "difficulty to instruct" in the health workshop in the nursing practice. These findings suggest the necessity of relating the classroom practice with nursing practice to provide educational guidance that enables students to conduct effective health workshops

健康教育とレクリエーション・リハビリとの合同演習の各段階での学生の学び

本研究の目的は、地域看護学と老年看護学で実施した健康教育とレクリエーション・リハビリの合同演習の計画・実施・評価段階での学生の学びを分析し、合同演習の教育効果と教育上の課題を明らかにすることである。学生の自己評価用紙の記述内容を検討した結果、54サブカテゴリー、14カテゴリーが形成された。14サブカテゴリーから合同演習での学びの構造化を図り、【学生の思考と行動】、【対象との相互作用】、【評価】の3つの大きなカテゴリーにまとめることができた。学生は、対象者との援助的人間関係やヘルスプロモーションの視点など従来の演習方法での課題を挙げており、既習の知識と技術の応用や統合など教育効果を確認できた。しかし、計画段階では場の雰囲気づくりや参加者の反応の把握や交流への視点をもちにくいこと、実施段階ではチームワークを図って運営することや対象者のヘルスプロモーションについての意識は薄いことが明らかになった。The purpose of this study was to investigate students\u27 learning in each of the planning, implementation, and evaluation stages of the joint practice of health education and recreational rehabilitation, which had been conducted in the classes of community and geriatric nursing, respectively, to identify the educational effects and future challenges to education of the joint practice. Students\u27 descriptions in a self-evaluation questionnaire were classified into 14 categories, which were integrated into 3 large categories: "the student\u27s thoughts and behavior," "interactions with the subject," and "evaluation." Some students mentioned assisting personal relationships with the subject and the viewpoint of health promotion, which were challenges to conventional methods for practice. With such an application/integration of existing knowledge and skills, certain educational effects beneficial to on-the-job training as well as post-graduation practicing were identified. However, it was also revealed that, in the planning stage, students put more emphasis on their assisting behavior, being less likely to pay attention to creating a favorable atmosphere, monitoring participants\u27 responses, and communicating with them, and that, in the implementation stage, they were less aware of conducting the practice as a team and promoting the subject\u27s health

Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study

Abstract Background Although Asian population was recognized to have a lower risk of venous thromboembolism (VTE), its increasing prevalence and incidence remain unclear in patients with malignancies. We attempted to predict VTE development using activation markers of coagulation and fibrinolysis. Methods We enrolled patients with malignancy admitted to Tonan Hospital between April and December 2014 to receive a new-for-them chemotherapy regimen. All patients were examined for VTE by computed tomography and whole-leg compression ultrasonography before chemotherapy and three months later. We also examined plasma levels of thrombin-antithrombin complex (TAT) and plasmin α2-plasmin inhibitor complex (PIC) before chemotherapy. The cut off values of TAT and PIC were set at 2.1 ng/mL and 1.8 μg/mL, respectively. Results Of 97 patients, the majority (67%) had distant metastases. The most common malignancies were colorectal (26%), breast (23%), and stomach (19%) cancer. VTE was detected in 29 patients (31%); all were asymptomatic. VTE was newly developed in 12 patients in the three-month observation period, which means the incidence was 49 per 1000 person-years. Non-increased PIC with increased TAT was the only significant risk factor for both VTE prevalence and incidence in multivariate analysis, and the odds ratios were 3.0 (95% confidence interval, 1.1–8.2; P = 0.034) and 9.4 (95% confidence interval, 1.7–51.9; P = 0.011), respectively. Conclusions The prevalence and incidence of VTE were high in hospitalized Japanese patients receiving chemotherapy for malignancies. Non-increased PIC with increased levels of TAT may be an independent risk factor for VTE development

The correlation between dietary habits and the knowledge of nutrition among elementary school children

本研究は, 小学生における食習慣と栄養知識との関連を明確にすることを目的とした. 2004年に二つの小学校で, 3年生から6年生の男児458名と女児443名, 合計901名を対象にアンケート調査を行った. 分析方法では, 累積ロジスティック回帰分析を行い, オッズ比と95%信頼区間を求めた. その結果, 好ましい食習慣がある児童は, 規則正しくない食習慣がある児童より栄養知識得点が高くなる傾向がみられた. さらに, 朝食を毎日摂取する児童は, 欠食する児童と比べ, 栄養知識得点が高くなることがオッズ比で示された. 今回の調査を通して, 朝食の摂取と栄養知識得点との関連をオッズ比で量的に明確にすることができた. 食習慣は児童の生活において大切な位置を占めている. 栄養知識の教育を通して, 食習慣を改善することが可能であることが示唆された

Physiological skin FDG uptake: A quantitative and regional distribution assessment using PET/MRI.

PurposeTo retrospectively assess the repeatability of physiological F-18 labeled fluorodeoxyglucose (FDG) uptake in the skin on positron emission tomography/magnetic resonance imaging (PET/MRI) and explore its regional distribution and relationship with sex and age.MethodsOut of 562 examinations with normal FDG distribution on whole-body PET/MRI, 74 repeated examinations were evaluated to assess the repeatability and regional distribution of physiological skin uptake. Furthermore, 224 examinations were evaluated to compare differences in the uptake due to sex and age. Skin segmentation on PET was performed as body-surface contouring on an MR-based attenuation correction map using an off-line reconstruction software. Bland-Altman plots were created for the repeatability assessment. Kruskal-Wallis test was performed to compare the maximum standardized uptake value (SUVmax) with regional distribution, age, and sex.ResultsThe limits of agreement for the difference in SUVmean and SUVmax of the skin were less than 30%. The highest SUVmax was observed in the face (3.09±1.04), followed by the scalp (2.07±0.53). The SUVmax in the face of boys aged 0-9 years and 10-20 years (1.33±0.64 and 2.05±1.00, respectively) and girls aged 0-9 years (0.98±0.38) was significantly lower than that of men aged ≥20 years and girls aged ≥10 years (pConclusionPET/MRI enabled the quantitative analysis of skin FDG uptake with repeatability. The degree of physiological FDG uptake in the skin was the highest in the face and varied between sexes. Although attention to differences in body habitus between age groups is needed, skin FDG uptake also depended on age