End-of-life care at the department of general medicine of a large hospital / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : To investigate end-of-life care at the Department of General Medicine of Saku Central Hospital (DGSCH).<br><b>Methods</b> : A retrospective survey of medical records of patients who died at DGSCH in 2011.<br><b>Results</b> : 101 patients died in that year. The average age was 85.2, and 73% patients lived in Saku city. The main causes of death were pneumonia (30%), cancer (20%) and senility (20%). Cardiopulmonary resuscitation was performed in 4% of patients. Total parenteral nutrition was performed in 8% and tube feeding therapy was performed in 12%.<br><b>Conclusion</b> : Patients who died at DGSCH were elderly patients who lived near the hospital, and most died without invasive medical procedures.

The usefulness and necessity of postgraduate community-based training program in Saku Central Hospital : Impact of implementation of the New Postgraduate Training System for Physicians / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : The objective of this research was to evaluate and to seek out factors that affect the usefulness and necessity of postgraduate community-based training programs in Saku Central Hospital (SCH) after the implementation of the New Postgraduate Training System for Physicians (NPTSP) <br><b>Methods</b> : A questionnaire survey of physicians who entered the residency program of SCH between 1996 and 2007 was conducted.<br><b>Results</b> : The questionnaire was sent to 111 physicians, and responses were received from 73 (65.8%). Of the reasons for selecting SCH for residency training, three showed significant increases after the implementation of NPTSP : the training system, the general medicine department/general outpatient clinic, and the overall ambience of the SCH staff. The usefulness of the community-based training program showed a 3.77 times higher odds ratio (OR) in male residents (95% CI, 1.31-10.9). Necessity was decreased after the implementation of NPTSP, showing an OR (95% CI) of 2.99 (1.05-8.55).<br><b>Conclusion</b> : Of the reasons why residents selected SCH, the management system for the residency program and the environment for general practice in the hospital became more important after the implementation of NPTSP. The need for a community-based training program in SGH was decreased after NPTSP emphasized primary care.

Candidemia in a Regional Hospital without Infectious Diseases Department / 日本農村医学会雑誌

  In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. <i>Candida albicans</i> was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.