Prevention of Delirium by Introducing Modified HELP (Hospital Elder Life Program) in Acute Medical Wards / 日本プライマリ・ケア連合学会誌

Introduction: This study examined the effectiveness of the modified Hospital Elder Life Program (HELP) for preventing delirium, which was adjusted to be used in acute internal medicine wards at general community hospitals in Japan.Methods: The pre-intervention group consisted of 751 patients aged 70 years or older hospitalized at Nishiyodo Hospital and Amagasaki Medical Co-op Hospital between January and July 2013. The post-intervention group consisted of 775 patients aged 70 years or older hospitalized between March and July 2017 and between October and December 2017. To address risk factors for delirium, a multicomponent intervention (modified HELP) consisting of the following was implemented: handing out pamphlets, orientation to maintain activity levels, sleep improvement, early initiation of rehabilitation, provision of glasses, hearing aids, and dentures, and the termination of continuous intravenous infusion. The Delirium Screening Tool was used to calculate the percentage of inpatients who developed delirium.Results: Of the 751 patients in the pre-intervention group, 108 (14.4%) developed delirium and 88 (11.4%) of the 775 patients in the post-intervention group exhibited delirium (odds ratio: 0.70; 95% confidence interval: 0.48-1.01; p=0.06).Conclusion: The modified HELP, adjusted for use in Japan, did not significantly reduce the rate of delirium during hospitalization. Therefore, a more universal intervention method is needed in the future.

A qualitative analysis of characteristics and problems of residency programs in community hospitals in Japan / 医学教育

Introduction: Differences in residency programs between large and small hospitals have not been shown in Japan.<br>Method: We performed a qualitative analysis of focus-group interviews of residents in community hospitals to investigate characteristics and problems of their residency programs.<br>Results: We found that residents in community hospitals treated difficult patients with the help of the medical staff; this cooperation was one of the most important characteristics of residency programs. We also found that residents tended to have less experience in emergency medicine and several other specialties.<br>Discussion: We found that residents in community hospitals learned how to treat difficult patients with the help of medical staff by means of a biopsychosocial model.

Epidemiological Studies of Yersinia pseudotuberculosis Infection by Plasmid DNA Profile Assay / 감염

BACKGROUND: In order to investigate transmission route of Yersinia pseudotuberculosis infection in Korea, we tried epidemiological study among human strains, mountain spring water strain and wild mouse strain which were isolated in north eastern area of Seoul on spring in 1996. METHODS: Plasmid profile (Restriction Endonuclease Analysis of Virulence Plasmid DNA analysis: REAP) assay in addition to serotyping were performed among human strains, mountain spring water strain and wild mouse strains. RESULTS: All isolates were the same O serotype of 4b and the same REAP pattern of type D. CONCLUSION: These results suggested that wild mice (especially Apodemus agrarius) were one of main reservoir of Y. pseudotuberculosis in Korea and their fecal material might contaminate mountain spring water. Most of human infections of Y. pseudotuberculosis were originated from drinking of contaminated mountain spring waters in Korea.

On French Pharmacovigilance System / 薬剤疫学

Spontaneous reporting system of adverse reactions (ADRs) is indispensable to secure drug safety. Although good systems of western countries are well-known in Japan, it seems that the French pharmacovigilance system is not familiar, as compared with the yellow-card system in the UK and the MEDWatch program in the US.<BR>This report outlines various features of the French system according to our information collected by a visit to the French medicines agency and one of the regional centers. The “good pharmacovigilance practices, ” enforced by the agency in 1995, is used as a reference.<BR>Notable features are summarized as follows : (1) decentralized activities by the 31 regional centers collecting spontaneous ADR reports from healthcare professionals, (2) centralized EDP-system retaining ADR data, (3) official decision-making process called “inquiry”, which opens when a signal of safety issues comes up, and synthesizes a consensus and proposal on necessary measures, (4) bidirectional communication between the regional centers and prescribers, reporting ADRs and providing safety information by Q & A, (5) collaboration of specialist committees and pharmaceutical companies with the above elements, and so forth.<BR>The system is characterized by these elements constructing collectively an effctive system to prevent ADRs and reduce the seriousness. These findings will be helpful, even in Japan, when subjects for improvement of a reporting system are discussed.