Purpose:
We previously reported that using D-phenylalanine (D-PA) as a pre-medication increasingly enhanced acupuncture aneshesia effects occur. In order to investigate this effect clinically, we performed tooth extractions under acupuncture anesthesia using D-PA as a premed.
Method:
We divided the patients in the oral surgery department of our hospital for whom acupuncture-moxibustion was determined indicated, into 2 groups, a test group (9cases) to which D-PA (4.0g) was administered 30minutes prior to acupuncture anestesia, and an acupuncture anesthesia only group (about 31cases), and comparitively examined results.
The points used were: LI-4 on both sides in all cases, and indicated local points selected from among JOKAN, ST-7, GV-26, ST-2, LI-20, CV-24, ST-6, SI-18 and ST-5. Needles were inserted (in some cases a point surface electrode was used) and the acupuncture sensation aroused, following which low frequency current at 3-15Hz was administered.
The tooth extractions were begun about 30minutes later. The standard for determining results was a score of 1=absolutely no pain, 2=slight pain, 3=very painful, 4=a small amount of local anesthesia administered, as supplement, 5=attempt to use acupuncture anesthesia abandoned.
Results:
In the control group effective results (score 1 or 2) were obtained in about 30% of the cases while in the test group there was almost no need for supplementary local anesthesia and generally effective results were obtained in most cases.
Summary:
The results were more excellent in the group in which D-PA was used as a pre-med for tooth extractions with acupuncture anesthesia than in the group in which it was not used.

  In order to intervene in the management of pain of cancer from an early stage. Our palliative care team (PCT), including pharmacists, makes the ward rounds (screening rounds) of the patients receiving opioids at our hospital. The purpose of this study was to analyze the effects of screening rounds activity by the PCT and its current problems, and to explore how to resolve the problems. We retrospectively studied the records of 196 patients who had receivede interventions by the PCT, with regard to intervention status and prescription proposal (228 subjects) about drug therapy by us. Study groups were as follows: 103 patients to whom interventions were deliveed at the request of medical doctors (intervention request group) and 93 patients who had interventions by the PCT after PCT-screening rounds (screening group). PCT-screening rounds caused to increase the number of interventions by the PCT. After PCT-screening rounds, the cases of intervention started by the request of medical doctors, who had given no heed to PCT intervention, also increased in numher. In this study, some problems with palliative intervention were also brought to light. Even in the screening group where the PCT largely intervened, 33% of prescription proposal by the PCT was ignored. This problem may be, at least in part, due to inadequate communication between PCT and ward staff through an electronic medical recording card, leading to poor relationship between PCT and ward staff. In the future, the PCT needs to work cooperatively with ward staff through direct communication such as medical conference to perform better intervention.