Moshiokuri, or explaining what one did to one's successor before calling it a day, has long been regarded as a practice indispensable for the smooth continuation of nursing business. However, there has been much to be done in terms of efficiency. In our hospital, moshiokuri was taken up as a problem because it took long and prevented nurses from getting down to work by bedsides without delay. In 1994 the nursing record committee started to examine the practice and improvedthe roster. Later, the card indexing system for individuals was abolished. In 1998, the nursing department made the abolishment of moshiokuri practice its chief aim to improve nursing efficiency. For the attainment of the aim, the nursing record committee played an important role as a prime mover. While exchanges of information between wards were being promoted, study sessions were frequently held to enrich nursing records and improve the efficiency of nursing work. Thus, moshiokuri was partlydiscontinued and abolished totally in March, 1999. Now, the nurses have plenty of timecaring bed-ridden patients. Improvement has been made on the nursing record.

BACKGROUND/AIMS: Recently, recombinant human soluble thrombomodulin (rTM) has been developed as a new drug for disseminated intravascular coagulation (DIC). This study aims to evaluate the clinical benefit of rTM in patients with sepsis-induced DIC caused by acute cholangitis who underwent biliary drainage. METHODS: Patients were divided into two groups: the rTM therapy group and the non-rTM therapy group. The primary outcome was the DIC resolution rate at 7 days, and the secondary outcome was 28-day mortality rate. RESULTS: Thirty-five patients were treated by rTM, and 36 patients were treated without rTM for DIC. The rate of resolution of DIC at day 7 was significantly higher in the rTM group than in the non-rTM group (82.9% vs 55.6%, p=0.0012). Compared with the non-rTM group, the 28-day survival rate of the r-TM group was significantly higher (rTM vs non-rTM, 91.4% vs 69.4%, p=0.014). According to multivariate analysis, non-rTM (hazard ratio [HR], 2.681) and CRP (HR, 2.370) were factors related to decreased survival. CONCLUSIONS: rTM treatment may have a positive impact on improving DIC and survival rates in patients with severe acute cholangitis.
Cholangitis* ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Humans ; Mortality ; Multivariate Analysis ; Survival Rate ; Thrombomodulin* ; Thrombosis

BACKGROUND/AIMS: Electrohydraulic lithotripsy (EHL) under endoscopic retrograde cholangiopancreatography (ERCP) guidance can be an option to treat difficult stones. Recently, a digital, single-operator cholangioscope (SPY-DS) has become available. Peroral transluminal cholangioscopy (PTLC) using SPY-DS has also been reported. In this retrospective study, the technical feasibility and clinical effectiveness of EHL for difficult bile duct stones under ERCP guidance and under PTLC guidance was examined. METHODS: In this pilot study, patients with difficult bile duct stones between July 2016 and July 2017 were retrospectively enrolled. RESULTS: Forty-two consecutive patients underwent EHL using a SPY-DS; 34 patients underwent EHL under ERCP guidance, and the other 8 patients underwent EHL under PTLC guidance. Median procedure time was 31 minutes (range, 19 to 66 minutes). The median number of EHL sessions was 1 (range, 1 to 2), and that of ERCP sessions was also 1 (range, 1 to 3). The rate of complete stone clearance was 98% (41/42). Adverse events such as cholangitis and acute pancreatitis were seen in 14% (6/42), which could be treated conservatively. CONCLUSIONS: EHL using SPY-DS was technically feasible, not only under ERCP guidance, but also PTLC guidance. A prospective clinical study of EHL using SPY-DS is needed.
Bile Ducts* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde* ; Cholangitis ; Clinical Study ; Common Bile Duct ; Humans ; Lithotripsy* ; Pancreatitis ; Pilot Projects ; Prospective Studies ; Retrospective Studies ; Treatment Outcome

Purpose: The purpose of this study is to develop a “Multidisciplinary Collaboration Ability Scale (MCAS)” and examine the reliability and validity for medical professionals engaged in cancer care. Method: The first MCAS draft was created, and the content validity and surface validity of the scale were examined for medical professionals. Next, a cross-sectional questionnaire survey was conducted on medical professionals engaged in cancer care who worked in medical institutions. Exploratory factor analysis and known-groups technique were carried out, coefficient α calculated, and concurrent validity examined. This study was conducted with the approval of the research ethics review. Result: Exploratory factor analysis resulted in 33 items of 4 factors (ability to promote discussion, foundational relationship building, self-control, and problem-solving activities). The MCAS score was significantly higher for those who had participated in a multidisciplinary workshop and those who had more years of experience. Coefficient α for the entire scale and for each factor was .80 and above. Examination of concurrent validity showed a moderate correlation. Conclusion: The reliability and validity of MCAS in its development stage were generally verified.