Effects of acupuncture stimulation on the lumbar area and those of electrical stimulation of the sciatic nerve on blood flow to the sciatic nerve were studied using laser Doppler flowmetry in anesthetized rats. Changes in the nerve blood flow induced by acupuncture stimulation were not similar. Half of the blood flow responses correlated with changes in arterial blood pressure. In the other half, responses did not always agree with changes in arterial blood pressure. Electrical stimulation was administered to the sciatic nerve contralateral or ipsilateral to the blood flow measurement site. Electrical stimulation of the ipsilateral side increased nerve blood flow without increasing arterial pressure. Administraton of atropine slightly diminished the response. Contralateral nerve stimulation, changes in nerve blood flow were not accompanied by arterial pressure changes. These results suggested that nerve blood flow may increase without increment of the arterial pressure in response to certain types of acupuncture stimulation.

To identify indications for acupuncture treatment, we examined certain evidence-based medicine (EBM) practices by acupuncture/moxibustion clinicians who are novices in this field and identified problems and solutions from the perspective of an acupuncture/moxibustion clinician.
We collected cases of lumbago, shoulder disorders and strokes from the literature, and critically assessed these reports. We also investigated Cochrane Library's acupuncture/moxibustion reviews and evaluated the quality of domestic studies using randomized controlled trials and controlled clinical trials (RCT/CCT). Simultaneously, one of the authors evaluated her own clinical reports in light of EBM.
As a result, acupuncture/moxibustion treatments showed promise for treating lumbago and shoulder disorders, but the higher the quality of studies, the lower the effect of treatment after stroke. According to research by the Cochrane Library (as of issue 1, 2003), the effects of acupuncture/moxibustion was measured only for cases of idiopathic headache but those for other disorders were measured more severely. In Japan, RCT started as early as the 1960 s, but the studies were sluggish and high quality studies were not produced until the late 1990 s.
We presented problems of RCT assessment score, the gap between RCT designs and actual clinical scenes, and the difficulty of masking at the bed-side. To contribute to the accumulation of more evidence-based data, it would be desirable for clinicians to acquire EBM methods, consider clinical problems and collaborate positively with investigators in the field.

OBJECTIVE: Carcinosarcoma of the uterine corpus has a poor prognosis. Although pathological necrosis is a prognostic factor of endometrial cancer, the clinicopathological influences of an unenhanced region observed on magnetic resonance imaging (MRI) are inconclusive. The aim of our study was to determine the clinicobiological impact of the presence of an unenhanced region on MRI, which can represent necrosis, in uterine carcinosarcoma. METHODS: The clinicopathological factors of 29 patients diagnosed with uterine carcinosarcoma were assessed retrospectively. The percentage of the tumor that was unenhanced on MRI was determined. The clinicopathological factors related to the unenhanced regions were evaluated. The prognostic significance was assessed using the Kaplan-Meier method and Cox regression model. RESULTS: Although the presence of pathological necrosis was not a poor prognostic factor (p=0.704), unenhanced regions on MRI correlated with poor prognosis when the unenhanced regions in the tumor accounted for more than 10% of the total tumor (p=0.019). The percentage of unenhanced regions was positively correlated with stage (p=0.028; r=0.4691) and related to tumor size (p=0.086; r=0.3749). The Cox regression analysis indicated that the presence of lymph node (LN) metastasis and more than 10% of the tumor being unenhanced on MRI were prognostic factors of overall survival in the univariate analyses (p=0.018 and p=0.047, respectively). CONCLUSION: The unenhanced region on MRI, which represents pathological necrosis, reflects tumor progression, and semi-quantification of the region is useful to predict the prognosis in patients with uterine carcinosarcoma.
Carcinosarcoma* ; Endometrial Neoplasms ; Female ; Humans ; Lymph Nodes ; Magnetic Resonance Imaging* ; Methods ; Necrosis ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Uterine Neoplasms

An alternative and augmentative communication (AAC) device replaces or supplements a person’s natural speech. Speech-Language Pathologists (SLPs) collaborate with a team of healthcare professionals in the process of identification and use of the right AAC device for a person with complex communication needs (CCN). In the Philippines, occupational therapists (OTs) and SLPs are more likely to collaborate in the treatment of their clients due to their interprofessional education (IPE) experience. However, most Filipino SLPs do not engage in interprofessional collaboration (IPC) when rendering AAC services. Thus, there is a need to identify existing literature that tackles collaborative practices to raise the quality of service and care. Hence, this study aimed to identify and discuss existing literature that documented IPE and IPC strategies between OTs and SLPs in the field of AAC. The structure of this literature review was guided and adapted from the topics outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Literature archived in two databases (Pubmed and Scopus) were reviewed. Two articles out of five studies were included in this review. Strategies found were “case based learning approach” for post-graduate students and the “Beyond Access model” in supporting practitioners. In conclusion, there is a dearth of literature on IPC practices among OTs and SLPs in the field of AAC. There is a need to report IPE and IPC efforts in the Philippines to provide applicable strategies to the local healthcare landscape.
Philippines

Assistive technology (AT) enables an optimized life for persons with disability through the scaffolding of functional capabilities. However, AT provision faces challenges such as long approval processes, funding inadequacies, and difficulties integrating evidence into practice. A means to address these issues is through interprofessional collaboration (IPC), the process by which health professionals efficiently coordinate and work with each other towards a common goal to maximize limited resources. To promote its effective implementation, there is a need to know the facilitators and barriers that affect its implementation. Thus, this paper aims to review the facilitators and barriers to the uptake of IPC in the field of AT within rehabilitation medicine identified by existing literature. This literature review followed the steps outlined by The Model Systems Knowledge Translation Center. Articles published between January 2000 until September 2019 were retrieved from four electronic databases (Cochrane Library, PubMed, Scopus, Science Direct). Three studies were included in the study. Facilitators identified were: (1) optimal work culture, (2) professional competence, and (3) associating with team members. Barriers to effective IPC in the field of AT were identified as: (1) presence of professional silos, (2) lack of unified language, and (3) gaps in bureaucratic support. The mechanisms and factors in implementing interprofessional collaboration identified by the World Health Organization are vital in the field of AT. However, the barriers identified above need to be addressed to promote the uptake of IPC within this specialized field.

OBJECTIVE: To validate the relationship between residual walking ability and monthly care cost as well as long-term care insurance (LTCI) certification level in elderly patients after surgical treatment for hip fractures in Japan. METHODS: Elderly patients aged >75 years who underwent surgical treatment for hip fractures in our hospital were included. The preand post-surgical (6-month) walking ability and LTCI certification and the presence or absence of dementia was determined from medical records and questionnaires. Walking ability was classified into 6 levels used in our daily medical practice. Based on these data, we correlated the relationship between walking ability and the LTCI certification level. Further, based on the official statistics pertaining to the average monthly costs per person at each LTCI certification level, we evaluated the relationship between walking ability and monthly care cost. RESULTS: A total of 105 cases (mean age, 80.2 years; 16 men; 39 patients with dementia) were included. The correlation between walking ability and average monthly cost per person as well as LTCI certification level at 6 months postoperatively (r=0.58) was demonstrated. The correlation was found in both groups with and without dementia. CONCLUSION: The ability to walk reduced the cost of care in elderly patients who experienced hip fracture, regardless of the presence of dementia.
Aged* ; Certification ; Cost-Benefit Analysis ; Dementia ; Hip Fractures* ; Hip* ; Humans ; Insurance, Long-Term Care ; Japan ; Long-Term Care ; Male ; Medical Records ; Mobility Limitation ; Walking*