Journal of rural medicine : JRM最新文献

Objective: Both acyclovir (ACV) and valacyclovir (VACV) can cause drug-induced encephalopathy, which occurs primarily in patients with renal impairment because of delayed drug metabolism. Here, we report a case of ACV-associated encephalopathy precipitated by the addition of nonsteroidal anti-inflammatory drugs (NSAIDs).

Patient: A 97-year-old woman with a 1-d history of altered consciousness was admitted to our hospital. After treatment with ACV and VACV for herpes zoster, NSAIDs were introduced for pain 5 d prior to admission. VACV and NSAIDs were subsequently administered by her primary care physician 3 d before admission.

Results: The patient presented with altered consciousness and acute kidney injury, leading to a suspicion of ACV-associated encephalopathy. Her consciousness improved rapidly with hemodialysis. We diagnosed ACV-associated encephalopathy based on a significantly elevated ACV blood level of 32.7 µg/dL.

Conclusion: The addition of NSAIDs during ACV or VACV administration may precipitate ACV-associated encephalopathy. When combining ACV or VACV with NSAIDs for the treatment of herpes zoster, careful monitoring of consciousness level and renal function is recommended.

Objective: This study aimed to identify prognostic factors for hypothermia, including hormone levels.

Materials and methods: This retrospective analysis used data from our department's database from November 2018 to December 2023. Inclusion criteria comprised cases with a prehospital diagnosis of hypothermia (body temperature <35°C) established by emergency medical technicians. Patients in cardiac arrest upon arrival were excluded from the study. This study investigated various parameters, including age, sex, body temperature, systolic blood pressure, heart rate, Glasgow Coma Scale (GCS) score, and adrenocorticotropic hormone (ACTH), cortisol, thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), free thyroxine (FT4), C-reactive protein, total protein, albumin levels, and outcomes. Patients were categorized into two groups based on the discharge outcome: fatal and survival groups. This study compared the variables between the two groups.

Results: There were 28 and 53 patients in the fatal and survival groups, respectively. The average heart rate and FT3 levels in the fatal group were significantly lower than those in the survival group. The average cortisol and CRP levels in the fatal group were significantly higher than those in the survival group.

Conclusion: This is the first report to demonstrate that hypothermic patients with a fatal outcome tend to have low heart rate, low FT3 levels, high cortisol levels, and inflammation upon arrival at the hospital. Further studies with larger sample sizes are needed to confirm the clinical significance of our findings.

Objective: Blood ketone monitoring is commonly used in the management of diabetic ketoacidosis (DKA). However, bedside ketone meters have limited availability in hospitals. This study aimed to clarify the correlation between blood ketones and blood gas analysis (BGA) in the treatment of DKA and thereby identify parameters that can be used as surrogates for blood ketones.

Patients and methods: This retrospective observational study included patients with DKA admitted to the JA Toride General Medical Center between November 2021 and March 2024. Multiple regression analysis was performed using blood ketone levels as the objective variable and BGA indices as explanatory variables. Additionally, the study evaluated 1) the time course of ketone levels and BGA indices during the DKA treatment and 2) the correlation between ketone levels and the BGA indices.

Results: Sixteen patients were enrolled. Multiple regression analysis showed that the corrected anion gap (cAG), defined as the anion gap minus lactate concentration, was a significant predictor of blood ketones. Among pH, HCO₃ ^-, and cAG, only cAG had significant regression coefficients (-0.061 [95% confidence interval (CI): -3.49 to 1.98], -0.233 [-0.156 to 0.0118], 0.636 [0.129 to 0.246], respectively; coefficient of determination: 0.765). The correlation coefficient between cAG and blood ketone levels was high (0.9694).

Conclusion: cAG levels strongly correlate with blood ketone concentrations and may serve as a surrogate marker for blood ketones in the management of DKA. Because measurements of the anion gap and lactate concentrations are inexpensive and widely available in most medical facilities, cAG is a promising indicator for DKA management.

Objective: To examine the clinical significance of elevated C-reactive protein (CRP) levels in cases of severe fever with thrombocytopenia syndrome (SFTS), with a particular focus on their role in predicting outcomes beyond that of previous reports.

Patients and methods: CRP values and SFTS case data retrieved from a PubMed search were extracted for analysis. For comparison, the subjects were divided into two groups based on their CRP levels: normal (CRP ≤0.3 mg/mL) and elevated (CRP >0.3 mg/dL).

Results: Forty-four cases were identified: 25 with normal CRP levels and 19 with elevated CRP levels. In an univariate analysis, no significant differences were observed between the two groups with respect to age, sex, date of blood examination, white blood cell count, outcome, or lactate dehydrogenase, alanine transaminase, creatine, or ferritin levels. However, the normal group contained a higher proportion of women, and the incidence of other infectious diseases was relatively low.

Conclusion: In cases of SFTS, a CRP level >0.3 mg/dL in the first collection indicates the potential for a mixed infection other than an SFTS-associated infection and male prevalence. Further prospective studies are necessary to confirm whether the findings of the present study are generalizable among patients with SFTS.

Objective: To determine the role of high-sensitive C-reactive protein (hsCRP) in predicting the severity of preeclampsia in a high-population, resource-poor country.

Patients and methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynaecology of Calcutta National Medical College, India, from March 2021 to September 2022. A total of 180 participants were divided into three equal groups: patients with severe preeclampsia and non-severe preeclampsia and healthy pregnant women.

Results: The levels of the biomarkers hsCRP and uric acid differed significantly between women with preeclampsia and healthy women, with cutoff levels of 3.72 mg/L and 5.15mg/dL, respectively, as determined using receiver operating characteristic (ROC) curve analysis. HsCRP was also able to differentiate severe preeclampsia from non-severe preeclampsia at a cutoff level ≥8.75 mg/L (high Youden index >0.6). However, uric acid levels failed to discriminate between pregnant women with severe and non-severe preeclampsia. Elevated hsCRP levels were strongly associated with low birth weight of newborns in pregnant women with preeclampsia and healthy control groups (P=0.001) and with disease severity (P<0.001), respectively.

Conclusions: HsCRP can be used as an important diagnostic tool to exclude and evaluate the severity of preeclampsia.

Objective: There exist many reports regarding employed cancer survivors continuing to work; however, studies regarding self-employed cancer survivors-especially farmers-are scarce. This study aims to determine how cancer survivors in agriculture cope with professional requirements and the concomitant challenges.

Methods: We conducted a descriptive qualitative study with eight cancer survivors, who were self-employed farmers, using semi-structured interviews. We followed Braun and Clarke's method for thematic analysis.

Results: Three themes emerged related to work continuity for cancer survivors in farming. Underlying the continuity of work for cancer survivors in farming was the idea of farming as a career. The support of family and friends enabled them to continue farming, even during periods of diminished physical ability. Their way of working was self-determined.

Conclusion: Cancer survivors in farming found the cooperation of family members and friends important for continuing farming and identified the need for supportive policies and interventions tailored to their needs. Such policies and support would help cancer survivors in farming continue their work and improve their quality of life.

Objective: In this study, we aimed to evaluate the "Scientific Meaning of Clinical Practice Workshop" held at the Wakayama Nursing Practice Research Center and clarify its effects and future tasks.

Participants and methods: Based on what nurses currently find beneficial and problematic about their research, we conducted a survey using a self-administered questionnaire among the nurses who participated in the workshop. The questionnaire was processed using Microsoft Forms. Eight of the nine clinical nurses who participated in the workshop participated in this study. This study was approved by the Ethics Committee of Tokyo Healthcare University. The participants provided written confirmation of their cooperation.

Results: Six categories were generated to demonstrate the effects and future tasks of the workshop. Several challenges faced by the participants were highlighted, including difficulties in determining research directions and managing time constraints. However, the workshop notably enhanced the participants' comprehension of nursing research and positively shifted their attitudes toward it. Other benefits, such as improved research skills and the ability to apply research findings to clinical practice, were also noted. The workshop underscored the value of peer support in fostering interest in nursing research and addressing common obstacles.

Conclusion: These findings reveal the importance of continuous education and support mechanisms for clinical nurses to overcome barriers and enhance their research capabilities. Future workshops should consider participants' needs for learning about research methods and ethics.

Objective: Nurse executives (NEs) working at rural medical facilities encounter challenges, including nursing quality and management, due to a shortage of nurses; this requires them to develop their competencies. A previous study reported that managers working in rural medical institutions gather nearby to learn about management. However, no research has focused on NEs working in rural areas or clarified their experiences in developing competency through learning networks. This study focused on the learning networks of NEs working in rural medical facilities and aimed to clarify their experiences with competency development.

Patients/materials and methods: In this study, we conducted competency development for NEs through the learning networks in Japan. An ethnographic qualitative study design was used. Twenty NEs participated in the study. Data were collected through participant observation and ethnographic interviews, and analyzed using thematic analysis.

Results: This study revealed the following three themes: (1) aiming to provide medical care that contributes to the rural community; (2) work efficiency by a small number of staff; and (3) development as NEs. The NEs in this study improved as NEs by promoting efficiency in their work with a small group, while aiming to provide medical care that contributes to the rural community through participation in a learning network.

Conclusion: A learning network of NEs develops their competencies by helping them improve their practice through dialogue and reflection on their nursing management. Therefore, even in an environment with limited resources, NEs might be able to improve the services of their organization through the learning network.

Objective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.

Materials and methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.

Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11-0.51). Patients without systolic hypotension were more frequently missed during diagnosis.

Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.

Objective: Under Japan's Long-term Care Insurance system, care managers (CMs) are expected to function as coordinators in the community-based integrated care system. However, few studies have focused on inter-professional collaboration between medical and non-medical professionals. The aim of this study was to identify CMs' perspectives on enablers and barriers to successful collaboration between care managers and physicians within the community.

Patient/materials and methods: We targeted care managers with ample experience working as CMs in the community and recruited 12 CMs using snowball sampling. Online interviews were conducted from January to May 2023 using an open-ended questionnaire concerning participants' experiences of collaborating with physicians and integrating medical services into care management. Qualitative data were analyzed through inductive manual coding using a qualitative content analysis approach.

Results: Four main themes were identified as enablers and barriers to successful CM-physician collaboration in the community: medical knowledge, professional attitudes, communication skills, and the professional culture of medicine. Equipping CMs with practical medical knowledge is essential for effective communication. Professional attitudes among CMs are imperative to fostering collaborative relationships. Effective communication skills are another critical factor, emphasizing the need for clarity, specificity, and utilization of nurses as key mediators in physician-care manager dialogue. Recognizing and navigating the professional culture of medicine is essential to overcome barriers stemming from differences in norms, beliefs, and practices between CMs and medical professionals.

Conclusion: This study underscores the significance of interprofessional education focusing on cultural differences and the development of systematic learning approaches to enhance CMs' medical knowledge of CMs. Furthermore, the findings highlight the need for clarity in defining CMs' roles within healthcare teams and addressing physicians' misperceptions regarding their contributions and responsibilities.