In order to predict bio-psycho-social-existential problems that patients may face after hospital admission, we developed a check sheet : Comprehensive Stress Check for Patients (CSCP). CSCP enables ...doctors and therapists to see how patients perceive their physical health, and psychosocial and existential problems at an early hospitalization period. We carried out a pilot survey in the Division of Geriatrics and Hypertension in Osaka University Hospital, where we are based. A total of 102 inpatients completed CSCP. As a result of factor analysis, we determined that 3 factors contributed to their subjective stress : “existential value,” “psychological environment in hospital” and “subjective physical and mental symptoms.” In our previous studies, we have noted that psychotherapists played a role in facilitating the understanding of patients in order to promote a better relationship between doctors and their patients. As this study was a continuation of our past research, we intended to create a tool that would help psychotherapists to share their expertise to understand patients with doctors. A further study will be needed to utilize CSCP in the way that will allow doctors, therapists and patients to work together towards the creation of better hospital environment.
Background
Spontaneous esophageal perforation is a potentially life-threatening condition with high morbidity and mortality rates. While surgical treatment has been employed for esophageal ...perforation, we have adopted conservative treatment with an esophageal stent for patients in a poor physical condition because we consider controlling sepsis and improving the physical status are the highest priorities; additionally, the surgical trauma could be fatal for these patients.
Case presentation
A 60-year-old male complaining of left chest and back pain after vomiting was transferred to a local hospital. Computed tomography and chest X-ray examinations showed left tension pneumothorax, pneumomediastinum, and bilateral pleural effusion suspicious of spontaneous intrathoracic esophageal perforation. He was transferred to our hospital for further treatment. After arrival, he developed septic shock with acute respiratory failure. We considered that surgical treatment was too invasive and chose conservative treatment with an esophageal stent. Under general anesthesia, we first inserted a 20-Fr. trocar in the left posterior pleural space, and a large volume of the dark pleural effusion was discharged. We then performed endoscopy and found a pinhole perforation in the left posterolateral wall of the lower esophagus. We inserted both a silicon-covered esophageal stent with a check valve and a double elemental diet (W-ED) tube. We then inserted an 18-Fr. trocar into the left anterior wall. These procedures were performed less than 24 h after onset. As intensive medical care, the patient was administered broad-spectrum antibiotics and catecholamine. The two trocars and the W-ED tube were under continuous suction at − 5 cmH
2
O and at − 20 cmH
2
O every 30 s. On the 6th day, we inserted an additional thoracic drainage tube into the left pleura under CT guidance. The patient was discharged from the ICU to the general ward on the 7th day. We removed the stent almost triweekly, and the esophageal perforation was completely healed on the 45th day. He was discharged home on the 70th day.
Conclusion
Conservative treatment with a temporary self-expanding covered stent with a check valve, sufficient drainage, and W-ED tube nutrition was useful and effective in this unstable case of spontaneous intrathoracic esophageal perforation.
Background: With the advent of molecular techniques, self-collected specimens without a clinician’s examination are often adequate to detect common genital infections. Objective: To evaluate the ...additional information that speculum and bimanual examinations provides clinicians in the routine evaluation of genital infections among attendees of a sexually transmitted disease (STD) clinic. Methods: Cross-sectional study from a database of all visit records to two STD clinics in Baltimore between 1996 and 2002. Women were stratified on the basis of reason for visit. Proportional and likelihood ratio estimates of the speculum examination in detecting clinically relevant cervicovaginal lesions (leading to a diagnosis of other infections or outside referral for further management) and bimanual examination in detecting abnormalities (leading to a diagnosis of pelvic inflammatory disease or referral) are presented. Results: 15 918 of 21 703 records were included: 12 073 were symptomatic (SYM; discharge, rash, abdominal pain, dysuria, genital irritation or odour), 1676 were asymptomatic contacts of an infected partner (CON) and 2169 were asymptomatic and presented for checkup (ASYM). The median age was 26 years; 94% were black. 11.8% of SYM, 4.6% of CON and 3.9% of ASYM patients had clinically meaningful lesions detected on speculum examination. The bimanual examination detected clinically relevant abnormalities in 6.5% of SYM, 0.8% of CON and 0.6% of ASYM patients. Conclusion: Symptomatic women are most likely to benefit from speculum and bimanual examinations. However, their yield in evaluating asymptomatic women is low. Prospective studies are needed to determine whether eliminating speculum and bimanual examinations in a subset of women would offer an operational advantage without compromising patient safety.
The aviation industry is a competitive and regulated business. It is a function of the engineering manager in aviation to ensure that the aircraft operates cost effectively. One way to manage ...aircraft operation cost is to speed up aircraft turnaround time during maintenance checks. According to airworthiness regulations, an aircraft has to go through A-check maintenance after a certain number of flying hours. Aircraft operators are faced with the challenge of delays during maintenance. These delays result in the loss of revenue because of penalties. To overcome this challenge, this research was conducted in an aircraft maintenance organization. The objective of the research was to identify the cause of delays during A-check maintenance. Maintenance records were analyzed and interviews were conducted with several employees of the aircraft maintenance company. The research identified the factors that contribute to delays during A-check maintenance. The identification of these factors will help the airline maintenance company to identify the gap between best practice and current practice.
Japan is a developed country, which has huge demand of riverflow as source of water supply for cities and industrial factories, but has enormous demand of diversion of riverflow for paddy irrigation. ...These facts give Japan peculiar characteristics from the hydrological and water resources engineering point of view. Analysis of records of diversion for paddy shows unit and diversion requirement. Return flow is discussed in its ratio to diversion and in its direction. Location of a check point for planning and operation of water resources systems in a basin is discussed, and applicability and the cases of application of a author's idea (the Critical Block Method) is introduced. In Japan, a new water supply requires a reservoir or water transfer to augumentate river flow in a dry spell, since almost all of available riverflow has already been diverted by many existing paddy irrigation systems. Unification of existing and candidate diversion of riverflow and a barier dam at river mouth are another requirement for new diversion. A “preference” rule has replaced a “priority” rule in these twenty years in Japan.
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