Usefulness of Computed Tomography Examination of Central Venous Lesions in the Shunt Arm / 日本農村医学会雑誌

Central venous lesions are suspected in dialysis patients who present with increased venous pressure and severe swelling of the shunt arm. Here, we report a case where contrast computed tomography (CT) was useful for diagnosis. Iopamidol 300 (20 mL) was diluted 2-fold, 30 mL of which was injected into the vein in the shunt arm at 2.0 mL/s. Imaging was started 10 s later. Fixed stenosis caused by intimal proliferation can be assessed just as effectively using contrast CT and shunt angiography. However, contrast CT is more useful than shunt angiography in the assessment of stenosis due to compression by surrounding organs and lesions, because the position of vessels relative to surrounding organs can be depicted. Contrast CT allows for safer and shorter examination compared with shunt angiography, and the diagnostic performance of a single examination can be improved using 3-dimensional reconstruction (3D) and multiplanar reformation images. Precise information obtained using contrast CT will contribute to safe and effective percutaneous transluminal angioplasty.

An Approach to Delivering Prophylactic Rehabilitation Interventions to Individuals in a Rural Area / 日本農村医学会雑誌

We started a prophylactic rehabilitation class from fiscal year 2016 and 1 year later we identified 4 problems, namely, a small number of participants (mean, 4.6), a small male population (ratio of 1 male to 9 females), no follow up because only 1 session was given per area, and a low home exercise rate (42.5%). For the class in fiscal year 2017, discussions were held with the comprehensive regional support center. Accordingly, relevant information was disseminated via public relations magazines, neighborhood circulars, and the local government to address the problems with the number of participants and sex ratio, and a series of 4 sessions were held per area to address the problems with the lack of follow-up and continuation of home exercise. Objective assessments (grip strength, one-leg standing, and knee extension strength) were included in the physical assessment. Through these measures, based on questionnaire results, we found that there was an increase in the number of participants and that more participants continued the exercise at home after the class was increased.

Current Status of a Community-Based Integrated Care System for Dementia in a Rural City Area in Gifu Prefecture / 日本農村医学会雑誌

The aim of this study was to determine the current situation in a rural community that is actively engaged in establishing a community-based integrated care system, especially for dementia, despite the community being at risk of becoming a marginal village. Six medical, longterm care, or welfare professionals in a rural area of City A, Gifu Prefecture were interviewed from May to September 2017 on the current status and challenges faced in establishing a community-based integrated care system for dementia. Qualitative data was structured by thematic analysis. Volunteer activities by long-term care facilities and an Osekkai (unsolicited) network comprising community specialists, social workers, and residents appeared to be foundational to the community-based integrated care system in the area. The key shared concept was that the intentional and proactive involvement of active elderly individuals as volunteers in community activities helps to prevent them from becoming dependent. Challenges to be addressed were providing these elderly individuals with opportunities to discuss their ideal final stage of life and to understand advanced care planning.