Need for Staff Education in the Importance of Clinical Research, Including Data Analysis, Conducted by Medical Staff / 日本農村医学会雑誌

　The number of medical staff who can conduct clinical research in our hospital has been decreasing every year, and thus education that enhances medical staff's understanding of the importance of clinical research is an important factor in improving patient management. Although staff education has begun to develop infrastructure necessary for conducting clinical research, it is unclear whether medical staff who must play a critical role in clinical research are actually interested in conducting research and participating in research-related educational programs. We carried out a cross-sectional questionnaire survey of medical staff to determine their interest in clinical research activities and related education. Of 894 medical staff who participated in a workshop at Anjo-Kosei Hospital, 718 responded to the survey (response rate: 80.3%), 24.9% of whom had experience in clinical research and 51.0% had an interest in the field and related data analysis. Furthermore, 51.0% of respondents showed demonstrable intention to participate in staff education. Such intention to participate was particularly obvious among clinicians, pharmacists, registered dietitians, radiologists, and rehabilitation therapists. Also, staff in their 30s and 40s were frequently interested in conducting clinical research and related data analysis. This suggests that these staff prefer a research environment where they can undertake clinical research soon after completing clinical training. Moreover, regarding the question of specific educational areas, statistical methods for data analysis garnered the highest interest, followed by methods of writing a research paper, use of statistical software, data interpretation, designing research, and identifying research topics. Therefore, such educational programs should be flexible to suit medical staff who perform data analysis as well as clinical research.

Investigation of Factors Affecting Cultivation of Organizational Identity Among Hospital Staff / 日本農村医学会雑誌

　　This study sought to elucidate factors that affect the cultivation of organizational identity among our hospital staff. We conducted a questionnaire survey among hospital staff (N＝894) from November 2012 to September 2013. The following items were queried: job category, age, sex, marital status, with or without children, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis. The response rate for the survey was 80.3%. Univariate analysis showed that all abovementioned parameters affected the cultivation of organizational identity. Further study using multivariate logistic regression analysis was performed to clarify which factors are significantly involved in the cultivation of organizational identity. Our results show that job category, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis are effective in cultivating organizational identity. These results suggest that a sense of professionalism as medical staff may play a critical role in the cultivation of organizational identity.

Effect on Penetrating the Organizational Climate of Staff Training on Collective Goals in a Hospital Organization / 日本農村医学会雑誌

　　This study sought to examine the impact of the approaches being taken to deal with current problems between the hospital and staff from the viewpoint of organizational identity. First, we devised educational strategies that allowed staff to speak directly to the hospital director. Next, the director spoke to staff about the background and history, the basic philosophy, and the vision of the hospital, as well as their place and mission in the community. We also conducted a 7-item questionnaire survey (1-5 graded Likert scale) of 894 staff from November 2012 to September 2013. Collection and response rates were 80.3% each. Regarding the direct communication between our hospital director with staff, response to the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood one's place and mission in the community” were significantly increased after the on-the-job training compared with before receiving the training. We confirmed that about 90% of staff understood the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood their place and mission in the community”. Also, two factors, “organizational identity” and “a sense of distance from the hospital organization”, were extracted from the 7 questions for factor analysis. The reliability of this scale was high and showed high internal consistency (Cronbach's α coefficient＝0.837 and 0.670, respectively). The results of these tests for validity of the scale indicate its high content validity. Together, these results suggest that direct communication between our hospital director and staff was extremely useful for penetrating the organizational environment and enhancing staff's organizational identity.

Factors Affecting Hospital Staff Behavior Toward Participation in Lectures and Workshops Held in the Hospital / 日本農村医学会雑誌

　　This study was designed to clarify the factors affecting hospital staff behavior toward participation in lectures and workshops held in our hospital. A questionnaire survey was conducted to evaluate staff background and staff participation in these events. The survey revealed that in the past year, 78.7% of staff had attended lectures or workshops at least once. The participation rate in lectures and workshops associated with medical safety and infection control was 50.4% and 38.4%, respectively. Additionally, the participation rate was dependent on job type. Of interest, staff behavior toward participation was strongly influenced by factors related to the training content, such as medical safety and infection control, but not by environmental factors, such as marital status and familial status (with or without children). The survey results also showed that factors related to “hassle”, such as rearranging their work hours to allow for participation, negatively affected active participation in meeting events. These results suggest that factors affecting hospital staff participating in these events may, in part, be implicated in professionalism as medical staff, and that this can be influenced by job type and motivation, rather than by environmental factors.

A Case of Diabetic Chorea Caused by Hyperglycemia during Anti-Androgen Therapy / 日本農村医学会雑誌

　　Anti-androgen therapy is commonly used for prostate cancer and it has been reported to induce severe hyperglycemia. Diabetic chorea is characterized by acute uni- or bilateral chorea or ballismus and hyperintensity of the striata on T1-weighted magnetic resonance imaging (MRI) images, and is associated with changes in the blood glucose level. We report here a case of diabetic chorea caused by severe hyperglycemia induced by anti-androgen therapy. A 71-year-old man received a diagnosis of prostate cancer and was given leuprorelin acetate (11.25mg, every 3 months) and bicalutamide (80mg/day). After the third injection of leuprorelin acetate, he developed involuntary movements of the right extremities. His glucose and hemoglobin A1c levels were found to be markedly elevated (691mg/dl and 19.5%, respectively), and brain MRI showed high-intensity areas in the left striatum on T1-weighted imaging. The diagnosis was diabetic chorea and he was admitted to our department. His involuntary movements diminished immediately after intravenous infusion of 500 ml saline. His blood glucose level was decreased after initiation of basal/bolus insulin therapy and discontinuation of leuprorelin acetate, but he gradually developed involuntary movement of right extremities again.

Significance of Questionnaire Survey to Recruits Conducted to Improve Quality of Our Hospital Training Program / 日本農村医学会雑誌

　　The main purpose of our hospital training program for newly hired employees at Anjo Kosei Hospital is to encourage them to learn basic knowledge to live as a member of society. In this study, questionnaire surveys for all recruits were carried out at the beginning, at the end of, and 6 months after the training program to evaluate the significance of the training program. The number of the study subjects who had our training program was 138 in 2012 and 146 in 2013. We have placed great emphasis on our fundamental principles for the recruits to learn. The series of surveys showed that the lecture given by our hospital director on the ideals of hospital care was well received by the recruits. Moreover, the experience-oriented training program also satisfied the participants greatly, as it included the tour of hospital, and the training of safety in medical treatment, infection control, and customer support. Additionally, the surveys found that our hospital training program allowed the new employees to deeply understand a basic knowledge to live as a member of society. Furthermore, the questionnaire survey made at 6 months after the training program revealed that over 80% of the recruits thought our training program would play an important role in promoting their job skill. These results suggest that questionnaire surveys are useful to evaluate the change in their ideas of the recruits before and after the training program, leading to an improvement of the quality of our hospital training program.

Intervention by PCT and Problems Awaiting Solution at Anjo Kosei Hospital: Usefulness of Rounds of Patients Receiving Opioids / 日本農村医学会雑誌

  In order to intervene in the management of pain of cancer from an early stage. Our palliative care team (PCT), including pharmacists, makes the ward rounds (screening rounds) of the patients receiving opioids at our hospital. The purpose of this study was to analyze the effects of screening rounds activity by the PCT and its current problems, and to explore how to resolve the problems. We retrospectively studied the records of 196 patients who had receivede interventions by the PCT, with regard to intervention status and prescription proposal (228 subjects) about drug therapy by us. Study groups were as follows: 103 patients to whom interventions were deliveed at the request of medical doctors (intervention request group) and 93 patients who had interventions by the PCT after PCT-screening rounds (screening group). PCT-screening rounds caused to increase the number of interventions by the PCT. After PCT-screening rounds, the cases of intervention started by the request of medical doctors, who had given no heed to PCT intervention, also increased in numher. In this study, some problems with palliative intervention were also brought to light. Even in the screening group where the PCT largely intervened, 33% of prescription proposal by the PCT was ignored. This problem may be, at least in part, due to inadequate communication between PCT and ward staff through an electronic medical recording card, leading to poor relationship between PCT and ward staff. In the future, the PCT needs to work cooperatively with ward staff through direct communication such as medical conference to perform better intervention.

Evaluation of the Introductory Education Programs for New Employees and Role of the Training and Development / 日本農村医学会雑誌

The main purpose of the introductory education programs designed for newly-hired employees at Anjo Kosei Hospital is to acquaint them with basic knowledge to live as members of society. In recent years, our training and development committee has been drawing up and implementing some introductory education programs about hospital regulations and philosophy for the new employees. The present study was carried out to evaluate the effects of the introductory education programs and the role played by our committee in the programs. Those who signed up for the introductory education programs were the subjects of this study. They were included composed of 154, 140, and 150 new coners in 1997, 1998, and 1999, respectively. Questionnaire surveys were conducted on them when they completed the programs. The training and development committee encouraged all of the new mployees, belonging to different occupational categories, to attend to the programs. Great emphasis who placed on education of the basic philosophy in our hospital. The surveys found that the education program about how to receive visitors was valuable to them, but they reduced education time about it clearly decreased their satisfaction level. The education program about the safety of medical treatment poorly contributed to their satisfaction even though the education time was extended. Among the programs, experience-oriented education programs, such as the in-house tour, the training of infection control, and the training of customer support, were accepted by them with enough satisfaction. These results suggested that the intervention to each program by the training and development committee is needed to satisfy the new employees by improving each program from an educational point of view.

The Actual Situation of Internship and On-the-Job. Training Program for Students and Business Workers at Anjo-Kosei Hospital / 日本農村医学会雑誌

  This research was carried out to review the current state of thinga involving trainees (students and business workers) accepted by Anjo-Kosei Hospital and to clarify the role the Education Center in our hospital is expected to play in supporting trainees. The subjects were medical and non-medical students and business workers who signedup for our internship program and junior and senior high school students who paticipated in the hands-on training program at Anjo-Kosei Hospital between April 2006 and March 2009. A total of about 1,300 students and business workers had experienced the actual hands-on work each year. The number of medical students accepted was 289, 289, and 339 in 2006, 2007, and 2008, respectively. Besides, the number of non-medical students also increased from 847 to 1,045 in the period of three years. The business workers accepted came from 15 different types of occupation. It was found that junior and senior high school students were interested in the nursing-care field and this seemed to help them consider seriously their life as students and members of society, leading to the increased number of students who joined our program. In addition, unfortunately, two-fifths of the program were unfavorable for trainees because of poor management. The present research suggested that the Education Center take on a signification role in managing the internship and the hands-on training programs to accelerate the potential of students and business workers.

Pharmaceutical Care to a Patient with Dysphagia Who Needs Gefitinib Chemotherapy / 日本農村医学会雑誌

Recently, in order to make chemotherapy, safer and more effective various forms of intervention by pharmacists are needed. In this paper, we report our experience in intervening in the administration of gefitinib to a patient with dysphagia. Chemotherapy with an intravenous drip injection to the 58 year-old woman admitted to our hospital for non-small cell lung cancer (NSCLC) was withdrawn due to severe pancytopenia after the first cycle of pharamcotherapy. Then, as an altermative, oral medication, of gefitinib was suggested by medical doctors. However, the oral administration was inappropriate to the condition of the patient. She was unable to keep taking gefitinib pills because she had been suffering from a progressive swallowing disturbance due to progressive non-small cell lung cancer. Thus, we proposed another oral administration method in which gefitinib was resuspended in thickening agents. This method made it possible for the patient to take gefitinib without any adverse events until the day before the patient died.

Study on the Significance of Pharmaceutical Care for the Rational Use of Drugs. (Part1) Usefulness of Drug Monitoring on Safety and Effectiveness of Drug Therapy / 日本農村医学会雑誌

To raise a level of safety and to enhance the effectiveness of complicated drug therapy, various drug monitoring programs have been implemented in these days. In the present study, we examined whether pharmaceutical care plans proposed by pharmacists contributed to drug therapy.The number of pharmaceutical proposals from pharmacists, which were adopted and put into poactice in the clinical stages, has increased annually and totaled 1,014 cases in the past four years. The number of proposals related to cancer chemotherapy increased remarkably. Moreover, most of the cancer-related proposals conserned drug dosage, suggesting that the pharmaceutical care by pharmacists may contribute to the safety management of drugs in drug therapy. Additionally, in the other clinical cases than cancer chemotherapy cases, there was an increase in the number of proposals based on patient's conditions and clinical examination data, which suggests frequent participation of pharmacists in drug therapy. Furthermore, it was found that 62.6% of the all pharmaceutical proposals were made by wards-resident pharmacists. This suggests that an increase in the numbrt of wards-resident pharmacists will contribute to more effective and safer drug therapy in the future.

Contribution to Drug Therapy of Therapeutic Drug Monitoring(TDM) / 日本農村医学会雑誌

It is known that drug disposition is altered by concurrent administration of different drugs. Drug-drug interaction may also enhance a side effect that is linked to either drug. The purpose of this report is to demonstrate the usefulness of therapeutic drug monitoring (TDM) in the early detection of side effects induced by drug-drug interaction and its treatment.<BR>The combined use of rifampicin and mexiletine may require an increase in the dose of mexdletin by about 50% due to increased clearance resulting from enzyme induction. In addition, three days after discontinuation of the rifampicin therapy, the serum mexiletine level increased from 0.83 mcg/ml to 2.44 mcg/ml. The patient has developed a tremor. After discontinuation of mexiletine medica-tion, the symptom disappeared in two days.<BR>On the other hand, the patient who took theophylline and mexiletine together developed nausea, vomiting and tachycardia. Four days after initiation of the combination therapy, the serum theophyl-line level was in the toxic range of 27.3 mcg/ml. The patient's theophylline dose was decreased 25%, and side effects completely resolved. The serum theophylline concentration became normal (18.8 mcg/ml) seven days later.<BR>Whatever the mechanism, these drug interactions may be sufficient to necessitate the adjustment of drug dosage, preferabily in accordance with serum drug concentration levels. These results suggest that TDM is useful for the suppression of incidence of side effects by drug interactions.