BACKGROUND : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.
OBJECTIVE : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.
DESIGN : Prospective observational study based on a daily questionnaire.
PARTICIPANTS : Residents of postgraduate year 1 and 2.
MEASUREMENTS : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).
RESULTS : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.
CONCLUSIONS : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.

Objective : To examine the relation between psychoactive drugs and the outcome of dysphagia in patients with psychiatric disorders. Methods : We examined 53 inpatients who were prescribed speech therapy in the psychiatry ward of our hospital from January 2011 to April 2012. We categorized the patients into a poor outcome group and a good outcome group by the necessity for alternative nutrition at discharge and analyzed the number and kind of typical antipsychotic, atypical antipsychotic, hypnotic, antidepressant and mood stabilizer, total amount of typical antipsychotic, atypical antipsychotic used at admission and at discharge, sex, psychiatric disorder, central nervous system disease, aspiration pneumonia, duration of hospitalization, psychiatric disorder disease period, speech therapy intervention period and GAF scale at admission. Results : The outcome of dysphagia had a significant relation with the number and kind of antipsychotic used, especially typical antipsychotic used at admission. The good outcome group had a higher total amount of antipsychotic use, especially atypical antipsychotics. Conclusion : Long-term practical oral intake should not comprise antipsychotic polypharmacy, especially typical antipsychotics before onset of dysphagia, but should instead consist of a monopharmacy approach with atypical antipsychotics.

The 38-years old woman was hospitalized due to peritonitis carcinomatosa after 8 months, since the operation for advanced gastric cancer. Although the dosage of domperidone suppository, metoclopramide injection and haloperidol injection was started to prevent her from vomiting, it was stopped because of the complication of extrapyramidal symptoms. Instead of previous prescription, the traditional Japanese medicine, ice candy of rikkunshito, was prepared and started to give her. After its dosage, the number of vomit was gradually decreased, and she was permitted to go back her home. Before a dosage of ice candy of rikkunshito, it was impossible for her to eat orally even if she felt hungry and had appetite, which caused a strong grief to her. Ice candy of rikkunshito is a smooth medicine and expected to prevent from vomiting while an intake of ice candy orally. Hence, it is considered that there is possibility to have effectiveness both physically and psychologically. After few days from going back home, she caused a consciousness impediment. Her last stay at home was only few hours. After one month since then, she died leaving her message,“I was tired out, but happy to stay at my home.”

  Introduction: We examined the thermophysiological effects of ultrafine bubble (UB) bathing in comparison with microbubble (MB) and freshwater (FW) bathing.   Subjects and Methods: Seven healthy women aged 35.6±2.9 years provided informed consent to participate in the study. After a 10-min rest, each subject engaged in UB, MB, and FW bathing (on separate days) at 40°C for 10 min. During the experiment, tympanic temperature, local sweat rate, local skin temperature, heat flow, and heart rate variability were continuously recorded. Subjective assessments of thermal sensation and comfort were rated on a visual analog scale between 0 to 100.  Results: Increases in tympanic temperature and mean body temperature were highest during MB bathing, and similar increases were observed during UB and FW bathing. Local sweating was highest during MB bathing and lowest during UB bathing. A significant interaction was observed between local sweating during bathing and bathing style (P<0.001). The increase in local sweat rate relative to body temperature was lowest during UB bathing and highest during MB bathing.  Discussion: During UB bathing, UBs and MBs that were generated in high concentrations in the bathtub decreased the flow of heat to the body, thereby suppressing an increase in tympanic temperature and yielding the lowest local sweat late. However, during MB bathing, in which a moderate concentration of UBs and MBs were generated, the increase in heat flow due to the convection of hot water exceeded the decrease in heat flow due to the bubbles.  Conclusions: The results suggest that bubble properties and convection characteristics altered the balance of heat flow, leading to differences in the thermoregulatory response during and after bathing.

Palliative care team（PCT）, nutrition support team（NST）and office of nutrition in our hospital developed a special soup service, which was served for ten patients faced with terminal cancer. The members of PCT, NST and the Cook served a special soup to ten patients. Nine of them could taste the soup without vomiting although they had anorexia. It was a good result. The number of days from the last day tasting the soup to death or hospital transfer was between 3 and 20 days（12.5 days on average）, and the number of times they could taste the soup was between 1 and 3（2.0 times on average）. Tasting the soup supports the strength of living, and might bring an improvement in spiritual quality of life.

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

Cholesteatoma is a cystic non tumorous lesion of the temporal bone that has the ability to destroy nearby structures by its power to cause bone resorption and as a result, fatal complications prevail. We aimed to conduct a comprehensive review for pathogenesis of acquired cholesteatoma, bone resorption mechanisms, and offer a future vision of this serious disease. We have reviewed different theories for pathogenesis of acquired cholesteatoma including the most relevant and updated ones with special emphasis on the mechanisms of bone resorption through Medline/PubMed research using the keywords ‘aetiopathogenesis, bone resorption, acquired cholesteatoma, temporal bone, and cytokines.’ In order to strengthen our study, we searched the reference lists of identified reviews. Cholesteatoma is a subject of debate among otolaryngologists since it was prescribed firstly. Over many decades, several theories were postulated for aetiopathogenesis of cholesteatoma with a tendency to follow more than one theory to explain the proper nature of that disease. Until now, the mechanism of bone resorption has yet to be more clarified. In the last century, a leap has occurred in the field of biomolecular cholesteatoma research which improved our knowledge about its pathophysiology and bone destructive mechanism. However, surgery is still the only available treatment. We conclude that discovery of new therapeutic choices for cholesteatoma other than surgery by the use of anti-growth, anti-proliferative, apoptotic agents as well as medications that antagonize osteoclastogenesis should be the main concern in the future clinical and experimental research work. Also, searching for predictors of the aggressiveness of cholesteatoma can affect the timing of intervention and prevent occurrence of complications.
Bone Resorption* ; Cholesteatoma* ; Cytokines ; Temporal Bone