Development of disaster pamphlets based on health needs of patients with chronic illnesses.

The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health. Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources. Each pamphlet consisted of seven sections-each section includes items common to all illnesses as well as items specific to each illness. The first section, "Physical Self-Care", contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the "Changes in Mental Health Conditions" section is to detect posttraumatic stress disorder (PTSD) at an early stage. The section "Preventing the Deterioration of Chronic Illnesses" is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, "Medication Control" and "Importance of Having Medical Examinations", spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, "Preparing for Evacuations" gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the "Methods of Contact in an Emergency" section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis. It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible.

Intraoperative spinal cord monitoring of C5 palsy after cervical laminoplasty.

STUDY DESIGN: Retrospective study of C5 palsy after laminoplasty for cervical myelopathy. OBJECTIVE: The objectives of this study were to investigate the morphologic characteristic of C5 palsy patients undergoing cervical laminoplasty with the intraoperative motor-evoked potential (MEP). SUMMARY OF BACKGROUND DATA: A study reported prophylactic foraminotomy for C5 paralysis after laminoplasty for cervical myelopathy. However, no indications have been established. There have been few reports on the intraoperative monitoring of the C5 palsy. This palsy is reported to happen a few days after the surgery in many cases, and the possibility of its detection by intraoperative spinal cord monitoring is unclear. METHODS: Of 153 patients with cervical myelopathy, 9 showed a decrease in upper muscle strength by 1 grade or more by postoperative manual muscle test. Of the 9 patients, 4 patients underwent segmental monitoring of upper limbs by MEP and were included in the paralysis group. Of the 153 patients, 74 (444 muscles) in whom both preoperative and postoperative manual muscle test of the upper limbs showed grade 5, and in whom the MEP monitoring of all these muscles was performed, were included in the nonparalysis group. We investigated the presence of intraoperative changes in 4 MEP parameters: amplitude, latency, duration, and waveform pattern, and the presence of foraminal stenosis in the cross-sectional view of preoperative myelographic computed tomography. RESULTS: In the paralysis group (9 muscles) and nonparalysis group (444 muscles), delay in latency was not observed in any muscle (0% and 0%), and 50% or more reduction of amplitude in 1 muscle (11%) and 22 (5%), prolongation of duration in 1 (11%) and 6 (1%), changes of waveform pattern in 3 (33%) and 40 (9%), and foraminal stenosis in 5 (56%) and 80 (18%), respectively. CONCLUSIONS: In the paralysis group, the incidences of waveform pattern change on intraoperative MEP and stenosis of the intervertebral foramen were higher than those in the nonparalysis group.

Health needs of patients with chronic diseases who lived through the great Hanshin earthquake.

OBJECTIVE: To identify the health needs of patients with chronic diseases who lived through the great Hanshin earthquake of 1995. METHODS: Twenty-nine patients with rheumatism, diabetes, or chronic respiratory disease were enrolled in the study. Semi-structured interviews were performed by the authors in 2004. RESULTS: Priorities for patients with all three diseases were securing medications and ensuring that they were able to take their medications. Rheumatism patients required methods of preventing their bodies from becoming cold, fatigued, and stressed in order to prevent aggravation of their disease; they also wanted relief workers to understand the physical limitations they experience. The health needs of diabetic patients included receiving an appropriate diet and developing ways to cope with the stress caused by the change in living environment. Patients with chronic respiratory diseases reported that their health needs included developing methods to prevent their bodies from becoming cold, fatigued, and stressed in order to prevent aggravation of their disease, access to respiratory masks to minimize dust and cold air exposure, and guidance in methods to alleviate respiratory symptoms. CONCLUSIONS: The emergency preparedness planning and care priorities for individuals with chronic health problems, such as rheumatism, diabetes, and pulmonary disease, should include attention to medication availability, stress management, support for activities of daily living, appropriate food, and availability of support devices necessary to minimize exacerbation of symptoms.