Objective : To investigate how rehabilitation outcomes improved after the rehabilitation plan was changed. Subjects : 54 patients that were admitted to a kaifukuki rehabilitation ward in a regional hospital from January 2007 to June 2007 and 679 patients that admitted from January 2008 to June 2011. Methods : We changed the rehabilitation plan as follows to improve rehabilitation outcomes. Physiatrists estimated the rehabilitation goal and the length of hospital stay (LOS) at the first examination. All patients had intensive rehabilitation with standing up exercises and ADL training toward the goal. LOS, Functional Independence Measure (FIM) gain, FIM efficiency and the percentage of patients discharged home during 6 months before the change were compared with those during the same period after the change. In stroke patients, hip fracture patients and deconditioned patients, the same comparison was performed. Results : In the 4 years after the change was initiated, LOS was reduced significantly from 96.5 days to 29.2 days (p<0.001). The change of FIM gain was not significant, but FIM efficiency increased significantly from 0.22 to 0.91 (p<0.001). The percentage of patients discharged home also increased significantly from 85.2% to 99.1% (p<0.001). Also in stroke patients and hip fracture patients, LOS was reduced and FIM efficiency was increased significantly. The sample of deconditioned patients was small, but their LOS was reduced significantly. Conclusion : The changed rehabilitation plan reduced LOS, increased FIM efficiency and enabled most patients to discharge home.

Background: Taking a good history is important for the diagnosis of abdominal pain. We investigated questionnaire items that were significantly correlated with causes of abdominal pain requiring hospitalization. We also studied the combination of responses that could exclude severe disease.
Method: Between February 2006 and December 2007, 296 of 317 patients with abdominal pain who attended our Outpatient Department completed a questionnaire for their abdominal pain. They included 32 patients requiring hospitalization (severe group) and 264 other patients (mild group). The percentage of positive responses to each questionnaire item was compared between the two groups, and those showing a significant difference were employed for logistic regression analysis.
Results: The following 4 responses were selected: “It is less than 7 days since the onset of pain” (odds ratio [OR], 2.8; 95% confidence interval [95% CI], 1.2-6.4); “The pain is exacerbated by walking” (OR, 2.8; 95% CI, 1.3-6.2); “The pain is accompanied by weight loss” (OR, 3.8; 95% CI, 1.5-9.8); and “The pain wakes me at night” (OR, 2.3; 95% CI, 1.1-5.2). If a patient had none of these responses, the predictive value was 0.03 for severe disease.
Conclusions: Our findings suggested that pain reported within 7 days, exacerbation by walking, nocturnal awakening, and associated weight loss are features of abdominal pain that predict severe disease. Conversely, severe disease can be almost completely excluded in patients negative for all 4 features.

The patch test is the most reliable method for diagnosing a metal allergy. However, interpretation of patch test results depends on the experience of the investigator and on the conditions of the individual patient. In the case of patch tests for metal salts, irritant reactions such as pustular or follicular reactions are quite common. Therefore, one must be careful not to interpret irritant reactions as allergic responses, and objective standards to evaluate erythema in patch tests need to be established.In the present study, we attempted to objectively evaluate patch test results for metal salts using an erythema index meter. We used the Erythema Index Difference (EID) (patch test site erythema index (EI) minus the mean EI of healthy skin outside the patch test area and at the unit tape site) rather than the EI itself in order to eliminate the effects of the patch test unit and individual differences. We measured the EID over time in patients with suspected metal allergies to various metals. Significant differences in EID were observed among ++ assessments, + assessments and irritant reactions based on International Contact Dermatitis Research Group (ICDRG) standards. In considering changes in EID over time, allergic and irritant reactions can be discriminated with high sensitivity (73.3%) and specificity (91.2%).These results suggest that the measurement of erythema over time with an erythema index meter is useful for the objective assessment of metal patch test reactions.

OBJECTIVE: To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients. METHODS: We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses. RESULTS: Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized > or =1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS. CONCLUSION: NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.
Adult ; Aged ; Aged, 80 and over ; Cytoreduction Surgical Procedures/*methods/mortality ; Disease-Free Survival ; Female ; Humans ; Lymph Node Excision/*methods/mortality ; Lymphatic Metastasis ; Middle Aged ; Neoplasms, Glandular and Epithelial/mortality/*surgery ; Ovarian Neoplasms/mortality/*surgery ; Retroperitoneal Space ; Retrospective Studies ; Treatment Outcome

Although palliative sedation therapy (PST) is considered to alleviate intolerable and refractory symptoms in dying patients with advanced cancer, there have been few studies regarding the situation of tertiary cancer center. We conducted a retrospective survey of the medical records of the patients who died between April 2015 and March 2016 at the National Cancer Center Hospital in Japan. PST was conducted in 75 out of 431 patients (17.4%). The patient demographics were as follows: sex (male/female), 48/27; median age, 61 years (range 5-83; 11 patients (14.7%) were aged under 39 years); and primary sites were lung, 18 (24.7%)/ pancreas, 11 (14.7%)/ hematopoietic organs, 11 (14.7%)/ bones and soft tissues, 8 (10.7%)/ and the others, 27 (36.0%). The main target symptoms for PST were dyspnea (38, 50.7%) and delirium (30, 40.0%). The most commonly used sedative agent was midazolam (72, 96.0%). Continuous deep sedation was intended in 61 patients (81.3%) at the death. Median survival from the start of PST were 2 days (range 0-54). The differences between palliative care team (PCT) intervention group and control group were lower age (58 vs. 62.5, P=0.048) and uniformity of initial midazolam dose (5-12 vs. 9.6-25.2 mg/day). Distinctive feature in this study was large proportion of adolescent and young adult patients with rare cancers. PCT might have different approaches to sedation in comparison to non-PCT medical staffs.