Impact of heavy rains of 2018 in western Japan: disaster-induced health outcomes among the population of Innoshima Island

Southwestern Japan suffered its worst rains in 2018 causing floods and mudslides, claiming 225 lives and forcing millions for evacuations. Referred as "Heisei san-ju-nenshichi-gatsugou", the disaster was the result of incessant precipitation caused by the interaction of typhoon "Prapiroon" with the seasonal rain front "Baiu". The present epidemiological study aims to investigate disaster-induced health issues in 728 residents of Innoshima island in the Hiroshima Prefecture by comparing their clinical data in pre-disaster (2017) and disaster-hit (2018) years which was obtained from annual health screening. Comparison of data showed a significant increase in the urine protein concentration in victims following the disaster. Probing further into the household conditions, showed that a total of 59,844 households were affected with water outage during the heavy rains, which was accompanied by severe damage of sewerage pipelines with complete recovery process taking two weeks. This two weeks of the crisis forced victims to refrain from using restrooms which in turn led to infrequent urination, thereby explaining the increased urine protein concentration in victims following the disaster. The present study addresses the acute health implications caused by the water crisis and serves as a precautionary measure for disaster management council to provide enhanced aftercare services in victims in further events of natural disasters

医事課ワークショップを通じて育むホスピタリティマインド

医療機関における医事課の役割は極めて重要で,医療事務は特殊な専門職として位置づけられている.一般に,医事課の仕事といえば診療報酬請求事務が大きなウエイトを占めているが,他に受付や電話対応,患者との直接の対応などに代表される接客業務がある.これには幅広い知識と豊かな人間性が求められ,特に窓口での印象は病院全体の印象として受け取られるので,最初と最後を担当するセクションとしての十分な自覚が必要である.このモチベーションを維持するためには,適切な教育環境が重要であることはいうまでもない.教育技法の一つに,参加者が主役となるワークショップがあり,会議や研修とは比べ物にならない高い教育効果が期待できる.今回,川崎医科大学附属病院開院以降,初めての「医事課ワークショップ」を開催し,テーマを「ホスピタリティマインド」とした.わずか3時間という短時間のワークショップであったが,課題が発見され,組織の結束が高まり,問題を解決するためのアイデアが浮かぶことに繋がったと思われる.「人と人とが響き合う病院」を目標に,今後も要望に応じて医事課ワークショップを開催していきたい.The medical affairs division of a healthcare institution has a vital role and medical administration is considered to be a particular type of specialist job. In general, a large part of medical administrative work is comprised of billing for medical treatment fees, but it also includes customer services such as hospital reception, call taking and patient liaison duties. Those engaged in hospital customer services are required to have extensive knowledge and a well-rounded character. Particularly, the impression they convey at the reception desk is perceived as that of the entire hospital. Thus, they need to be well aware of the importance of their role as handlers of both the first and the last phases of patients\u27 experiences with the hospital. To maintain this level of motivation among hospital customer service workers, an appropriate educational setting is absolutely essential. One of these educational tools is workshops, which allow the participants to play the leading role. Educational effects of workshops are incomparably greater than those of meetings or training seminars. We recently held the first "Medical Affairs Division Workshop" since the inception of Kawasaki Medical School Hospital under the "Hospitality Mindset" theme. Although the workshop was only three hours long, it helped us identify challenges, strengthen our solidarity as an organization, and develop ideas to resolve problems. With the aim of creating a hospital where "people are in tune with one another", we will continue to organize Medical Affairs Division workshops as the demand arises

Development of primary central nervous system post-transplant lymphoproliferative disorder immediately after cytomegalovirus viremia in an MDS patient who received cord blood transplantation

　Epstein–Barr virus (EBV) plays a central role in the pathogenesis of posttransplant lymphoproliferative disorder (PTLD), and EBV reactivation after allogenic hematopoietic stem cell transplantation (allo-HSCT) is highly correlated with cytomegalovirus (CMV) reactivation, which might be a risk factor for PTLD. We encountered a myelodysplastic syndrome patient with PTLD in the central nervous system who experienced sequential CMV and EBV reactivation immediately after allo-HSCT. Previous studies have suggested relationships between CMV and EBV reactivation and between CMV reactivation and PTLD. Our case suggests the importance of CMV monitoring in patients after allo-HSCT to preventPTLD

Human bone marrow VCAM-1+ macrophages provide a niche for reactive and neoplastic erythropoiesis

Resident bone marrow macrophages provide a microenvironment for erythropoiesis, forming erythroblastic islands (EBIs) via adhesion molecules. In this study, we examined vascular cell adhesion molecule-1 (VCAM-1) expression in human bone marrow specimens using immunohistochemistry. VCAM-1 was strongly expressed in CD169+ macrophages in EBIs and weakly in sinusoidal vascular endothelial cells. In reactive erythropoiesis, including hemolytic and megaloblastic anemia, the extended cytoplasm of VCAM-1+ CD169+ macrophages circumscribed the erythroid cells. The strong affinity between VCAM-1+ macrophages and erythroid cells was also observed in polycythemia vera (PV), essential thrombocythemia (ET), and chronic myelogenous leukemia (CML). VCAM-1 density was significantly higher in PV than in ET and CML (p < 0.001), and correlated with blood erythrocyte count in all three neoplasms (p < 0.001). In ET, the VCAM-1 density was higher in cases with the JAK2 mutation than with the CALR mutation. In myelodysplastic syndrome with erythroid predominance but unclear EBI formation, punctate VCAM-1+ cytoplasmic processes of macrophages were seen between erythroblasts, similar to those seen between granulocytic precursors in CML, suggesting incomplete contact of VCAM-1+ macrophages with dysplastic erythroid cells. These results suggest that VCAM-1+ macrophages create a niche for reactive and neoplastic erythropoiesis and may be a therapeutic target in PV

Folliculotropic mycosis fungoides treated with electron beam therapy that evolved into fatal, tumor-stage mycosis fungoides and erythroderma with multiple ulcerations

　A 71-year-old woman diagnosed with mycosis fungoides with multiple erythematous plaques and follicular papules on the scalp, trunk, and thigh was referred to our institution. Folliculotropic mycosis fungoides was histologically diagnosed, and the erythematous papules and plaques regressed temporarily after total-skin electron beam therapy. The patient then developed tumors and erythroderma. The area of painful erosion spread, and her condition rapidly worsened. The patient died 3 years and 4 months after the first examination due to multiple organ failure caused by sepsis. The cause of rapid evolution into erythroderma remains elusive and requires further investigation in similar cases