Patient safety education at Japanese nursing schools: results of a nationwide survey.

BACKGROUND: Patient safety education is becoming of worldwide interest and concern in the field of healthcare, particularly in the field of nursing. However, as elsewhere, little is known about the extent to which nursing schools have adopted patient safety education into their curricula. We conducted a nationwide survey to characterize patient safety education at nursing schools in Japan. RESULTS: Response rate was 43% overall. Ninety percent of nursing schools have integrated the topic of patient safety education into their curricula. However, 30% reported devoting less than five hours to the topic. All schools use lecture based teaching methods while few used others, such as role playing. Topics related to medical error theory are widely taught, e.g. human factors and theories & models (Swiss Cheese Model, Heinrich's Law) while relatively few schools cover practical topics related to error analysis such as root cause analysis. CONCLUSIONS: Most nursing schools in Japan cover the topic of patient safety, but the number of hours devoted is modest and teaching methods are suboptimal. Even so, national inclusion of patient safety education is a worthy, achievable goal.

Two metachronous tumors induced by radiation therapy: case report and review of the literature.

Various radiation-induced tumors, including meningioma, glioma, and sarcoma, have been reported; however, metachronous intracranial double tumors induced by radiation therapy are extremely rare. A 1-year-old boy had undergone tumor removal and craniospinal radiation therapy (30 Gy) for cerebellar medulloblastoma. At 24 years old, parasagittal meningioma developed in the left parietal region and was totally removed. Six years later, an infiltrative tumor was newly found in the right fronto-temporal white matter. The patient underwent stereotactic biopsy, and the tumor was found to be an anaplastic astrocytoma. Chromosomal analysis by fluorescence in situ hybridization (FISH) revealed loss of heterozygosity (LOH) of 1p. As the patient had previously had craniospinal irradiation, no additional radiation therapy was delivered. He underwent chemotherapy with temozolomide and the disease is now stable. Since both secondary tumors were located within the area of previous radiation and the patient did not have any genetic disease predisposing him to tumors, radiation therapy was considered to be responsible for their tumorigenesis. To our knowledge, this case is the fourth case of radiation-induced double CNS tumors arising after radiotherapy to be described in the literature. Whenever radiation is administered to children or young adults, careful serial screening studies are needed.

Morphological differentiation of bone marrow stromal cells into neuron-like cells after co-culture with hippocampal slice.

Adult green mice marrow stromal cells were co-cultured with hippocampal slices. Differentiation to neuron-like or non-neuron-like cells occurred exclusively inside slice boundaries starting at day 3, and then decreased gradually over 35 days. Neuron-like cells tended to form network-like connections around day 14. The use of retinoic acid greatly increased the number of differentiated cells, and the most effective concentration was 10(-6) M. NeuN immunohistochemistry was positive in 9.6+/-1.7% of morphologically differentiated neuron-like cells. Both GFAP and Iba1 immunostaining were negative. We concluded that bone marrow stromal cells can be differentiated into neurons, and direct contact with the host brain tissue is essential for this to occur. Retinoic acid significantly increases the number of differentiated cells, as has been reported with other stem cells.

Treatment of recurrent craniopharyngiomas.

One of the most common complications of craniopharyngioma treatment is recurrence. The outcomes of treatment for recurrent tumors with different modalities were evaluated. Of the 61 patients treated initially, 24 had recurrence during follow-up period (1-29 years, mean 11 years). Twenty-two patients underwent a total of 35 additional operations for recurrence. With reoperation, total surgical removal was achieved for four occasions (Group a), subtotal resection was achieved with 31 surgical procedures. Nineteen procedures (Group b) were done without radiotherapy and seven were followed by radiotherapy (Group c). Seven patients were treated with radiosurgery (Group d) with or without surgical resection. The surgical mortality rate for Group a was 50% which was higher than for initial operation, while for Group b 10.5% and none for Groups c and d. Good functional status was maintained at follow-up in 50% of survived patients for Group a, 14% for Group b, 57% for Group c and 86% for Group d. The 5-year recurrence free survival rate was 50% for Group a, 16% for Group b, 80% for Group c, and 83.3% for Group d. The rate of recurrence free survival for Group b was significantly lower than Group c (P = 0.004) and Group d (P = 0.001). The recurrence free survival rates were higher for Groups c and d than for Group b. The mortality and morbidity higher in the Group a. Radiotherapy and radiosurgery are useful adjuncts for the treatment of recurrence, resulting in a high recurrent-free survival rate with better functional outcome.

Surgical experience with skull base approaches for foramen magnum meningioma.

The surgical treatment of patients with foramen magnum meningioma remains challenging. This study evaluated the outcome of this tumor according to the evolution of surgical approaches during the last 29 years. A retrospective analysis of medical records, operative notes, and neuroimages of 492 meningioma cases from 1972 to 2001 identified seven cases of foramen magnum meningioma (1.4%). All patients showed various neurological symptoms corresponding with foramen magnum syndrome. The tumor locations were anterior in five cases and posterior in two. Surgical removal was performed through a transoral approach in one patient, the suboccipital approach in three, and the transcondylar approach in two. Total removal was achieved in all patients, except for one who refused any surgical treatment. The major complications were tetraparesis and lower cranial nerve paresis for tumors in anterior locations, and minor complications for posterior locations. One patient died of atelectasis and pneumonia after a long hospitalization. The transcondylar approach is recommended for anterior locations, and the standard suboccipital approach for posterior locations.

Complete penetration of the optic chiasm by an unruptured aneurysm of the ophthalmic segment: case report.

BACKGROUND: It is well known that aneurysms of the ophthalmic segment sometimes elevate the optic nerve or chiasm, and in case of large or giant aneurysms, the optic apparatus can be dramatically thinned. Nonetheless, they rarely penetrate the optic pathway completely. To our knowledge, no previous reports have dealt with the complete penetration of the optic chiasm by unruptured aneurysms of the ophthalmic segment. CASE DESCRIPTION: A 70-year-old woman presented with visual dysfunction in her left eye that she had experienced for several months. Her left visual acuity had rapidly deteriorated to the level of finger counting and visual field testing demonstrated nasal hemianopsia in the left eye and upper temporal quadrant hemianopsia in the right eye. Left internal carotid angiograms and three-dimensional digital subtraction angiograms showed an aneurysm of the ophthalmic segment projecting superomedially. Intraoperative findings revealed complete penetration of the optic chiasm by the fundus of the aneurysm. The optic pathway adjacent to the dome had become remarkably thin and dark yellow. After clipping was completed, the fundus of the aneurysm was punctured to decompress the optic chiasm. Postoperatively, patient's visual acuity in the left eye gradually recovered, but the visual field deficit persisted after the operation. CONCLUSION: This rare case demonstrates the potentially aggressive behavior of unruptured aneurysms of the ophthalmic segment. Patients with unruptured aneurysms of the ophthalmic segment who present with visual symptoms should be treated with surgical clipping to decompress the optic pathway as soon as possible.

Effect of boron neutron capture therapy for melanotic and amelanotic melanoma transplanted into mouse brain.

In order to develop a protocol to treat brain metastatic melanoma using our 10B-p-boronophenylalanine (BPA) boron neutron capture therapy (BNCT), we initiated the following studies (i), Comparative analyses of boron biodistribution between melanoma proliferating in the brain and skin among melanotic and amelanotic types, and (ii) Therapeutic evaluation of BPA-BNCT for brain melanoma models of both types, using survival times. Our present data have revealed that boron concentration in melanoma proliferating in the brain, the major prerequisite for successful BNCT, showed a positive correlation to melanin synthesizing activity in the same way as melanoma proliferating in skin. Further, the boron concentration ratio of melanoma to normal surrounding tissue for brain melanoma models was considerably higher than that for subcutaneous (s.c.) ones because of the existence of the blood-brain barrier (BBB). Additionally, from analyses of median and mean survival times following BNCT using low, middle, and high neutron doses, the therapeutic effect of BNCT for the amelanotic A1059 melanoma appeared at first glance to be higher than that for the highly BPA attracting and highly relative biological effect equivalent dose obtaining B15b melanoma. As the survival time was dependent on both regression and regrowth curves, and because the brain melanoma model in small animals made it difficult to evaluate these curves separately, we further examined the in vivo growth curve of both types of melanomas following implantation in s.c. tissue. The melanotic B15b melanoma was indeed found to possess much higher growth rate as compared with that of the amelanotic A1059 melanoma. The significance of boron biodistribution studies and BNCT survival curve analyses in forming an effective clinical protocol for individual human cases of melanoma brain metastasis is discussed.