Objective: This study aimed to identify factors associated with stress responses among hospital nurses during the prolonged COVID-19 pandemic.

Methods: A self-administered anonymous questionnaire was conducted with 538 nurses working at a university hospital. Stress responses were measured using six indicators from the Brief Job Stress Questionnaire: vigor, irritability, fatigue, anxiety, depression, and physical complaints. Related factors included job stressors such as interpersonal conflicts, buffering factors such as support from supervisors, and the impact of daily life changes due to the COVID-19 pandemic. Multiple regression analyses were conducted with stress responses as dependent variables and related factors as independent variables.

Results: Overall, stress response scores among the participants were not particularly high. The strongest association was found between anxiety and the job stressor of “qualitative job workload.” In addition, all stress responses except for vigor showed weak associations with “the reduction or absence of leisure activities” due to the pandemic.

Conclusion: During prolonged outbreaks of emerging infectious diseases, qualitative workload was found to be associated with stress. This suggests that providing support for nurses assigned to unfamiliar departments due to ward reorganizations is essential for alleviating stress. Furthermore, a lack of leisure activities was related to multiple stress responses, suggesting that promoting recovery experiences - such as how nurses spend their time off - may help mitigate stress responses.

Introduction: Remimazolam is a novel benzodiazepine characterized by rapid onset and offset owing to its unique ester bond, which is rapidly hydrolyzed in the liver. Although the effects of benzodiazepines, including remimazolam, tend to be enhanced in elderly patients necessitating lower maintenance doses, the relationship between aging and remimazolam, which requires maintenance doses in clinical settings, remains unclear.

Methods: We conducted a retrospective study of patients who underwent general anesthesia with remimazolam-remifentanil-rocuronium at our facility over two years. Exclusion criteria included emergency surgeries, surgeries lasting<one-hour, preoperative benzodiazepine use, liver dysfunction, and American Society of Anesthesiologists Physical Status≥IV. Overall, 148 patients were included in this analysis. Remimazolam dosage was adjusted to maintain bispectral index values between 40 and 60, and the remifentanil dosage was adjusted to stabilize the mean arterial pressure. Pearson’s correlation analysis was used to assess the relationship between remimazolam maintenance dose and patient age.

Results: A significant negative correlation was found between patient age and maintenance dose of remimazolam (r＝－0.557; p<0.001),indicating that older patients required lower doses. Specifically, the maintenance dose of remimazolam decreases by approximately 1% for each additional year of age. No significant correlation was observed between remifentanil dose and age (r＝－0.068; p＝0.419). Owing to the relatively high proportion of elderly patients in our study population, several cases of delayed recovery were observed. None of the patients included in this study had intraoperative awareness.

Conclusion: Elderly patients require a lower maintenance dose of remimazolam for anesthesia than younger patients. Overall, the maintenance dose of remimazolam for general anesthesia tended to decrease with advancing age. Our clinical data supports the importance of the relationship between maintenance dosage of remimazolam and age.

Background/Purpose: Regional formularies that list the recommended drugs for regional healthcare systems, should reflect local prescription trends. This study examined the use of medications for non-communicable diseases in community pharmacies in Maebashi, Gunma, Japan.

Methods: A cross-sectional survey targeting all community pharmacies in Maebashi was conducted between August and September 2020. We collected data on drug names, dosage forms, strength, and the total number of drugs dispensed to the six therapeutic drug groups during a three-month period, from November 2019. Data collection was performed using a mailed questionnaire to ensure responses could be gathered in written form. The dispensing percentage by ingredient was compared with the national data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data Japan. In addition, generic drug use was analyzed based on the type of neighboring medical institutions.

Results: The survey response rate was 67.5％ (of 106/157 individuals), and the dispensing trends in Maebashi were similar to national trends. However, pharmacies near hospitals had a higher proportion of drugs without generic alternatives, whereas pharmacies near clinics had a higher proportion of generic drugs in their frequently prescribed drug groups.

Conclusion: Although the overall prescription trends in Maebashi were similar to national patterns, the differences that were identified between medical institutions suggest that establishing a regional formulary could be beneficial for standardizing drug prescription practices.

Objective: This study aimed to clarify the nursing job stressors and coping strategies of ward nurses with Highly Sensitive Person (HSP) characteristics.

Methods: A web-based questionnaire was administered to approximately 600 ward nurses. The survey included the HSPS-J19 (Takahashi, 2016), the Nursing job stressor Scale (Higashiguchi, 1998), and the Coping Scale (Ozeki, 1993).

Results: A total of 184 valid responses were analyzed. The total HSPS-J19 scores were significantly higher in women than in men (p＝0.047). The high-scoring group had significantly higher scores than the low-scoring group for all seven work stressor factors. In addition, the high-scoring group for the aesthetic sensitivity subscale of the HSPS-J19 had significantly higher scores for emotion-focused coping. Binomial logistic regression analysis using total HSPS-J19 scores as the dependent variable revealed higher odds ratios for the Nursing job stressors “conflict with other nursing staffs” and “qualitative work load.”

Discussion: Nurses with HSP characteristics are strongly affected by work stressors, suggesting the need to consider stress reduction strategies.

Objective: To examine whether self-compassion and assertiveness reduce low mental well-being caused by nurses’ job stressors.

Methods: An anonymous questionnaire survey of approximately 1,000 ward nurses at five acute-care hospitals in the North Kanto region was conducted. The survey included the World Health Organization-Five well-being index, the Japanese version of the Self-Compassionate Reactions Inventory, the Japanese version of the Rathus assertiveness schedule, and the Nursing Job Stressor Scale. Binomial logistic regression analysis with mental health as an objective variable was performed by years of nursing experience.

Results: There were 575 valid responses (55.7%). Low self-compassion led to low mental well-being regardless of years of nursing experience. Meanwhile, Low assertiveness and higher level of the job stressor “death and dying” led to low mental well-being in nurses with ≤5 years of experience, whereas higher levels of the job stressor “quantitative work load” led to low mental well-being in nurses with ≥6 years of experience.

Discussion: Different job stressors affecting mental health depend on years of experience. Therefore, the development of self-compassion and assertiveness corresponding to these factors may be effective for improving nurses’ mental health.

　　Gangrenous cholecystitis (GC) is a severe and potentially fatal form of acute cholecystitis and therefore requires early surgical treatment. However, lack of specific abdominal symptoms of GC hinders its early diagnosis. Here we present the case of a patients with severe asymptomatic GC who was diagnosed with repeat imaging and persistently elevated inflammatory markers.

　　A 56-year-old man with a 26-year history of type 2 diabetes mellitus (DM) and 6-year history of hemodialysis due to DM nephropathy was diagnosed with acute cholecystitis based on computed tomography. He had no fever, abdominal pain, or abdominal tenderness and was initiated antibiotic treatment. While the patient did not develop abdominal pain or fever, laboratory tests such leukocytosis and high C-reactive protein level indicated inflammatory response. Follow-up computed tomography obtained seven days after treatment initiation revealed pericholecystic abscess, and he underwent emergency cholecystectomy. Intraoperative findings showed circumferential necrosis of the gallbladder, and pathological diagnosis was GC. The postoperative course was uneventful.

　　Early deterioration of acute cholecystitis to GC should be considered, regardless of the clinical findings, in patients with severe DM complications.

A 76-year-old woman accidentally ingested a medication tablet along with its press-through package (PTP). She presented with pharyngeal and epigastric discomfort and was subsequently transported to the emergency department. Abdominal computed tomography (CT) confirmed the presence of a PTP in the stomach, and emergency endoscopy was planned. However, following CT imaging, the patient experienced mild vomiting. Upon performing the endoscopic examination, no PTP was identified in the stomach. Further inspection of the vomitus revealed the PTP embedded within food remnants. No gastrointestinal injuries were observed, and the patient was discharged following the procedure. At a follow-up visit one week later, all symptoms had resolved.

PTPs are widely utilized for medication packaging, but accidental ingestion remains a notable concern, particularly among elderly patients. In most cases, PTPs become lodged in the esophagus due to their rigid structure and sharp edges, necessitating endoscopic removal. This case highlights the potential for spontaneous expulsion through vomiting. Clinicians should carefully examine vomitus in cases of suspected PTP ingestion and remain vigilant for possible gastrointestinal injuries, even if the PTP is expelled.

Spontaneous urinary extravasation is considered to a decompression mechanism in which a microscopic rupture occurs in the mucosa of the renal fornix due to a sudden increase in renal pelvic pressure, leading to urine leakage into the retroperitoneal space. It is considered to be often caused by a temporary and acute rise in renal pelvic pressure. We report a case of spontaneous urinary extravasation in an elderly bedridden woman, presumably triggered by chronic urinary retention. The patient was 71-year-old woman receiving home medical care for Alzheimer’s disease. She had been receiving intravenous therapy for several days due to poor oral intake. Because of fever and vomiting, she was suspected to have intestinal obstruction and was transported to our emergency department. A non-enhanced CT scan revealed moderate urine collection in the bilateral retroperitoneal spaces and severely dilated bladder within the pelvic cavity. She was admitted to the hospital with a diagnosis of pyelonephritis, retroperitoneal urinary extravasation and urinary retention. About 1,200 mL of urine was drained by urethral catheterization. Subsequently she was referred to the urology department. Since the urinary extravasation into the retroperitoneal space appeared to have improved with reduction of renal pelvic pressure by catheterization, a conservative observation was recommended. A follow-up non enhanced CT scan two weeks later confirmed resolution of extravasation. Chronic urinary retention due to an underactive bladder was suggested. Removal of urethral catheter was attempted with urapidil administration, but spontaneous urination did not occur. At the family’s request, the patient was discharged home while maintaining urethral catheterization. On a follow-up non enhanced CT scan three month later, no recurrence of urinary extravasation was observed, indicating its resolution.

We experienced a case with an intraductal papilloma arising from minor salivary glands of the tongue. The patient, a 33-year-old woman, came to our hospital with a complaint of a mass on the right side of the tongue. A mass was palpated in the submucosa behind the right lingual border. The size was the tip of the index finger and the elasticity was elastic hard. Imaging examination revealed a 13 mm nodule with well-defined borders showing uniform contrast effect, suggesting that it was not a malignant tumor. No abnormalities of tongue movement, sensation, or taste were observed, and blood tests showed no abnormal finding. We performed fine-needle aspiration cytology and found no malignancy. As a diagnostic treatment, a tumor resection was performed under general anesthesia, resulting in a diagnosis of intraductal papilloma. At 1 year postoperatively, there was no local recurrence on visual examination. Although many cases of intraductal papilloma are reported to have a good prognosis with tumor excision alone, since recurrence or malignant transformation is possible, early excision and follow-up are recommended when intraductal papilloma is mentioned in the differential diagnosis.

Case 1: A 58-year-old woman with type 2 diabetes mellitus under the treatment of SGLT2 inhibitor, who had genital candidiasis, was diagnosed with intravesical fungus ball by the complaint of floating particles in the urine. By repeating irrigation therapy, a fungus ball was crushed and removed, and it was cured for 8 months without any recurrence.

Case2: A 88-year-old man with chronic heart failure under the treatment of SGLT2 inhibitor, who had genital candidiasis and severe preputial ring stenosis, was diagnosed with intravesical fungus ball by complaint of floating particles in his urine. A fungus ball was crushed manually by vibration under ultrasound imaging. In addition, the treatment for preputial ring stenosis improved urination. Floating particles of a fungus ball were completely excreted over a period of about 4 weeks and were cured for 3 months without any recurrence. Intravesical fungus ball is a rare condition, however, in the case of a patient with hyperglycosuria complaining of floating particles in the urine, it must be included in the differential diagnosis.

Objective: This study aimed to clarify the attitudes of medical university students regarding supporting students with attention deficit hyperactivity disorder (ADHD) characteristics.

Methods: An anonymous web survey was administered to approximately 200 medical university students in their third or fourth year majoring in nursing or occupational therapy.

Results: A total of 129 valid responses were analyzed. Approximately 60％ of the students correctly understood ADHD characteristics. Some respondents had images of ADHD characteristics, perceiving having ADHD as being “restless, odd, and rude.” On the other hand, the perception that individuals with ADHD characteristics are “not scary” and “should not be criticized” was associated with attitudes toward support. Significant differences were observed in attitudes regarding supporting students with ADHD characteristics in terms of empathy toward the problems they face, such as “often being forgetful,” and supportive actions undertaken by respondents, such as “confirming submission deadlines with such students.”

Discussion: The results showed that the positive attitudes of medical university students toward supporting students with ADHD characteristics were related to their images of ADHD behavioral characteristics and their support for students with ADHD-related problems based on empathy, rather than their knowledge of ADHD behavioral characteristics.