Assessment of a Rapid Antigen Detection Kit for Diagnosis of Mycoplasma pneumoniae in Pediatric Community-Acquired Pneumonia / 日本農村医学会雑誌

RibotestMycoplasma (Ribotest™), a rapid antigen detection assay for ribosomal protein L7/L12 for the diagnosis of Mycoplasma pneumoniae infection, has become available in Japan. However, the clinical utility of Ribotest remains controversial. We enrolled 1,140 children admitted to our hospital between January 2014 and March 2016 due to community-acquired pneumonia. We prospectively obtained two throat swabs during the acute phase; DNA detection using a loop-mediated isothermal amplification (LAMP) assay and antigen detection using Ribotest were performed for each sample. We also collected paired serum samples during the acute and convalescent phases for determining M. pneumoniae antibody titers using the particle agglutination test. M. pneumoniae pneumonia was diagnosed through either a positive LAMP assay or a 4-fold increase in antibody titers. Overall, 237 children (21%) were diagnosed with M. pneumoniae pneumonia. We evaluated the utility of Ribotest both in the non-epidemic period (January 2014–July 2015) and the epidemic period (August 2015–March 2016). Sensitivity of Ribotest for M. pneumoniae pneumonia was 23% in the non-epidemic period and 22% in the epidemic period, respectively. When serology was used as the standard, sensitivity of Ribotest was 25% in the non-epidemic period and 22% in the epidemic period, significantly lower than those of the LAMP assay (80% and 91%, respectively). Ribotest yielded false-positive results in 16 cases in the non-epidemic period and in 6 cases in the epidemic period. Thus, positive predictive values of Ribotest were significantly lower in the non-epidemic period (50%) than in the epidemic period (86%). Multivariate analysis showed that a shorter duration of fever before sampling (OR = 1.7) and a higher incidence of co-infection with other pathogens (OR = 29.4) were observed in children showing false-positive results of Ribotest. Thus, we conclude that Ribotest is unsuitable for rapid diagnosis of pediatric M. pneumoniae pneumonia.

Measures to Prevent Accidental Ingestion among Children with Food Allergy at Our Hospital / 日本農村医学会雑誌

　　There is a need for measures to prevent accidental ingestion at hospitals that provide food for children with food allergies. The dietetics department of our hospital attempts to prevent accidental ingestion by providing meal tags that clearly indicate the dishes prepared without allergens (“allergen-free meal”), which are attached in the designated area by a licensed cook in charge of food preparation. During the 1-year period between January and December 2014, 258 children with food allergy were treated in our hospital and received allergen-free meals. There were 3 cases in which dishes containing allergens were served by mistake, and accidental ingestion by the patient occurred in 2 cases. Regarding the cause of these serving errors, it is likely that they occurred because allergen-free dishes were served using tableware with the same color as that used for allergen-containing dishes. Accordingly, we have revised our preventive measures against accidental ingestion so that all of the tableware and trays used for allergen-free dishes are yellow in color, in order to distinguish them from other dishes. Furthermore, we have provided a dedicated shelf for allergen-free dishes, and have also made it a requirement for final confirmation to be performed by 2 responsible cooks who double-check the food before serving. We will continue to monitor and improve our measures to prevent accidental ingestion as necessary.

‘Febrile Children's Menu’ for Children with Fever / 日本農村医学会雑誌

  The incidence of fever in children admitted to general hospitals is very high. Provision of adequate nutrition and fluid supplements to febrile children is very important, but with some children it is difficult to maintain an adequate intake. To address this problem, we devised a new ‘febrile children's menu’, utilizing preparation methods and foods to produce a palatable menu for patients with fever.<br>  We introduced this ‘febrile children's menu‘ on January 6, 2011, providing it to 109 patients (age range: 1 to 8 years, average age: 3.3±1.9 years) over the ensuing 3-month period. We provided a mean 4.0±2.9 meals per day to each patient during their febrile stage (≥37.5°C). To evaluate the usefulness of the ‘febrile children's menu’, we investigated eating rates during the febrile period in all patients who had been provided with the menu, and performed a questiomaire survey on their parents/guardians. The mean eating rates during the febrile period were 39±30% for main meals, and 28±22% for side dishes. No significant difference was seen in the eating rates during the febrile period recorded over the 2-month period prior to introduction of the new menu to 112 febrile children (age range: 1 to 8 years, average age: 3.3±2.1 years), 39±30% for main meals, and 29±22% for side dishes. The questionnaire survey was responded by 43 parents/guardians (a recovery rate of 39%). The ‘febrile children's menu’ was assessed as ‘good’ by 67% of respondents, representing an overall favourable impression from the parents/guardians. With reference to the survey results, we will attempt to further improve the ‘febrile children's menu’ with the aim of increasing eating rates during the febrile period.

Dietary Education for Child Inpatients and their Parents Questionnaire Surveys / 日本農村医学会雑誌

  In recent years, changes in Japanese dietary habits have been associated with the increased incidence of obesity and lifestyle diseases even among children. Dietary education is considered essential for stemming this trend. In this study, we introduced the following initiative in dietary education for children admitted to hospital and their parents from the standpoint of health care workers providing meals to inpatients. We added a ‘Children's Lunch’ to the menu. Designed for the fussy children, it was a nutritionally balanced meal. On traditional seasonal festival days, we wrote an introduction to Japanese seasonal cuisine and showed it to the children. To the parents, we distributed a regular weekly pamphlet outlining the importance of dietary education, with an explanation of the ingredients used in the meals, and recipes.  To assess the results of this initiative, we conducted a questionnaire survey of parents on a weekly basis. The results of the surveys (n=215, recovery rate 87%) taken during the first three months showed that the majority of parents rated all four aspects of the ‘Children's Lunch’ high menu content, presentation, child's response, and the pamphlet contents. The parents displayed a deep interest in our activity, because 93% of those parents said that they were impressed with dietary education. On the other hand, some dietary problems were identified, with tendencies to use only ingredients preferred by the children, and eat out often.  This was a short term initiative, limited to hospitalization, but we were cwetain that we had been able to provide an opportunity for parents to think about their children's diets. We plan to continue this initiative, thereby making a contribution to dietary education for children.

Quick-Drying Hand Disinfectants Reconsidered-For Prevention of Hospital Floors from getting Stained- / 日本農村医学会雑誌

In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.

Quick-Drying Hand Disinfectants Reconsidered / 日本農村医学会雑誌

In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.

Analysis of Accident Reports from the Staff of Nutrient Department in Showa Hospital / 日本農村医学会雑誌

From April 1, 2002 through March 31, 2003, 158 accident reports were submitted from 35 staffers of the nutrient Department in Showa Hospital. We analysed the causes of accidents with the aim of preventing future accidents. It was found 90 cases were attributable to errors in paperwork (57%), 56 cases dul to waiting errors (35%), eight cases to foreign body contamination (5%), and four cases to other resons (3%). Most accidents occurred by lack of confirmation, and it seemed that thoroughness of affirmation such as repetitive affirmation by a plural number of staffers prevent accidents. We should feed back both contents and causes of these accidents to all the employees, and should make a new guideline for accident prevention.

Usefulness of Psychological Testing in Diabetic Education / 日本農村医学会雑誌

The purpose of educating patients with diabetes mellitus (DM) is to facilitate their understanding of the disease and treatment, as well as to motivate the patients to improve their lifestyle. We recently assessed whether the results of psychological tests to investigate the mental status of DM patients were useful in obtaining a better outcome of education. The subjects were 75 DM out patients who were receiving treatment at out hospital (age range : 15-85 years, mean age : 66 years). The psychological tests were performed during a diabetic seminar held on February 26, 2002, using the Center for Epidemiologic Studies Depression Scale (CES-D Scale) and the Coping Inventory for Stressful Situation (CISS).On the CES-D scales, 20 points or higher scores were marked by 16 patients (21.3%), indicating a strong tendency to depression among DM patients. Assessment by the CISS showed a higher score on the task-oriented coping scale (T scale) than on the other scales (p<0.05), suggesting that DM patients are well-oriented towards the continuation of treatment. The CES-D Scale score tended to be higher in patients with an uncontrolled HbA1C (≥8%) (p<0.05), suggesting that a persistent depressed status is associated with poor glycemic control. The results of these psychological tests appeared to be useful in working out a more effective educational program for DM patients.