Case: A 40-year-old woman. Clinical diagnosis: Autistic disorder with mild mental retardation. Case report: The patient underwent pancreaticoduodenectomy for the treatment of her pancreatic cancer. We held several conferences with individuals from different medical fields and examined the influence of the patient's autistic disorder on the perioperative conditions. The senior author, a clinical psychologist, conducted repeated individual, acceptive, and sympathetic interviews with the patient and her family and maintained supportive relationships with them as an honorary family member. Thus, the clinical psychologist helped reduce the patient's anxiety about the medical treatment. Conclusion: The participation of a clinical psychologist in the medical conferences enabled the medical staff to understand the complications involved and provide mental support to the patient and her family. Palliat Care Res 2010; 5(2): 323-326

  Recently, the number of outpatients who visit the hospital only for the examination is increased in Ofuna Chuo hospital.  It is important that the pharmacists manage the contrast media used to these outpatients for the rational drug therapy.  However, there are a few hospitals where the pharmacists work in the laboratory.  Therefore, we investigated the effect of the providing drug information by pharmacists to the patients received magnetic resonance cholangiopancreatography (MRCP) in the laboratory.  The subjects were consisted of 38 patients who were taken with Bothdel®Oral Solution 10 during receiving MRCP.  The pharmacist instructed the patients about Bothdel®Oral Solution 10 before MRCP.  The percentage of patients who were already treated with the other drugs was 92.0%.  The 4 patients were taken the drugs interacted with Bothdel®Oral Solution 10 and then were able to prevent the drug interaction by the pharmacist.  Also, the patients were taken the questionnaire form about the adverse events of this drug and sent it to the pharmacy by mail after more than 5 days.  As the results, the gastrointestinal symptoms such as a loose stool and a diarrhea were reported 28.5% of the patients.  In addition, as the adverse events other than listed in the package insert, epigastric distress, heaviness of the head and hot flash, were shown in each of a patient, respectively.  In conclusion, it was very important that the pharmacists provide the information of rational use of contrast media to the patients who received examination.

A 69-year-old man was admitted for treatment of thoracic aneurysm. DSA revealed multiple aortic aneurysms: three true aneurysms which were located at the distal arch, the thoraco-abdominal aorta at the diaphragm level and the infrarenal abdominal aorta, 60mm, 55mm and 55mm in diameter, respectively and two pseudo-aneurysms which were located in the abdominal aorta just below the right renal artery and the right common iliac artery. We decided to perform a two-staged operation. Before the first operation, 1, 200ml of autologous blood was stored for perioperative blood transfusion. Initially, total arch replacement was performed using deep hypothermic circulatory arrest and antegrade selective cerebral perfusion. One month after the first operation, total thoraco-abdominal aorta replacement was performed by a retroperitoneal approach with mild hypothermia. The Th 9, 10 and 11 intercostal arteries were reconstructed. Distal anastomosis was performed at both common iliac arteries. Blood transfusion was not required for blood pooling and reduction of priming volume in the cardiopulmonary bypass system.

　　This study was designed to clarify the factors affecting hospital staff behavior toward participation in lectures and workshops held in our hospital. A questionnaire survey was conducted to evaluate staff background and staff participation in these events. The survey revealed that in the past year, 78.7% of staff had attended lectures or workshops at least once. The participation rate in lectures and workshops associated with medical safety and infection control was 50.4% and 38.4%, respectively. Additionally, the participation rate was dependent on job type. Of interest, staff behavior toward participation was strongly influenced by factors related to the training content, such as medical safety and infection control, but not by environmental factors, such as marital status and familial status (with or without children). The survey results also showed that factors related to “hassle”, such as rearranging their work hours to allow for participation, negatively affected active participation in meeting events. These results suggest that factors affecting hospital staff participating in these events may, in part, be implicated in professionalism as medical staff, and that this can be influenced by job type and motivation, rather than by environmental factors.

　　This study sought to examine the impact of the approaches being taken to deal with current problems between the hospital and staff from the viewpoint of organizational identity. First, we devised educational strategies that allowed staff to speak directly to the hospital director. Next, the director spoke to staff about the background and history, the basic philosophy, and the vision of the hospital, as well as their place and mission in the community. We also conducted a 7-item questionnaire survey (1-5 graded Likert scale) of 894 staff from November 2012 to September 2013. Collection and response rates were 80.3% each. Regarding the direct communication between our hospital director with staff, response to the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood one's place and mission in the community” were significantly increased after the on-the-job training compared with before receiving the training. We confirmed that about 90% of staff understood the items “background and history of our hospital”, “espoused the basic philosophy of our hospital”, “had a collective vision our hospital”, and “understood their place and mission in the community”. Also, two factors, “organizational identity” and “a sense of distance from the hospital organization”, were extracted from the 7 questions for factor analysis. The reliability of this scale was high and showed high internal consistency (Cronbach's α coefficient＝0.837 and 0.670, respectively). The results of these tests for validity of the scale indicate its high content validity. Together, these results suggest that direct communication between our hospital director and staff was extremely useful for penetrating the organizational environment and enhancing staff's organizational identity.

　　This study sought to elucidate factors that affect the cultivation of organizational identity among our hospital staff. We conducted a questionnaire survey among hospital staff (N＝894) from November 2012 to September 2013. The following items were queried: job category, age, sex, marital status, with or without children, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis. The response rate for the survey was 80.3%. Univariate analysis showed that all abovementioned parameters affected the cultivation of organizational identity. Further study using multivariate logistic regression analysis was performed to clarify which factors are significantly involved in the cultivation of organizational identity. Our results show that job category, participation in lectures or workshops in the previous year, and experience in clinical research and related data analysis are effective in cultivating organizational identity. These results suggest that a sense of professionalism as medical staff may play a critical role in the cultivation of organizational identity.

　The number of medical staff who can conduct clinical research in our hospital has been decreasing every year, and thus education that enhances medical staff's understanding of the importance of clinical research is an important factor in improving patient management. Although staff education has begun to develop infrastructure necessary for conducting clinical research, it is unclear whether medical staff who must play a critical role in clinical research are actually interested in conducting research and participating in research-related educational programs. We carried out a cross-sectional questionnaire survey of medical staff to determine their interest in clinical research activities and related education. Of 894 medical staff who participated in a workshop at Anjo-Kosei Hospital, 718 responded to the survey (response rate: 80.3%), 24.9% of whom had experience in clinical research and 51.0% had an interest in the field and related data analysis. Furthermore, 51.0% of respondents showed demonstrable intention to participate in staff education. Such intention to participate was particularly obvious among clinicians, pharmacists, registered dietitians, radiologists, and rehabilitation therapists. Also, staff in their 30s and 40s were frequently interested in conducting clinical research and related data analysis. This suggests that these staff prefer a research environment where they can undertake clinical research soon after completing clinical training. Moreover, regarding the question of specific educational areas, statistical methods for data analysis garnered the highest interest, followed by methods of writing a research paper, use of statistical software, data interpretation, designing research, and identifying research topics. Therefore, such educational programs should be flexible to suit medical staff who perform data analysis as well as clinical research.

It is well known that decreased physical performance induces the decreased activity of daily living and increment of mortality rate in elderly subjects. On the other hand, a prolonged heart rate corrected-QT (QTc) interval is associated with an increased risk of cardiac sudden death and cardiac autonomic dysfunction. We investigated the associations between physical performance and QTc interval in elderly subjects. The subjects included 605 elderly persons (274 men and 331 women, age; 71.2±4.7 years) without a history of cardiovascular disease and taking cardioactive drugs. Resting 12-leads electrocardiography was measured after more than 5 minutes of rest. The QTc interval was calculated according to Bazett’s formula. The physical fitness test was performed to determine the physical performance (muscle strength, balance and walking abilities). The subjects were divided into four categories, which were defined as equally quantile distributions of QTc interval. The physical performance levels were significantly lower in the longest QTc interval group compared to the shortest QTc interval group in both men and women (p<0.05, respectively). Moreover, after adjusting for the age, the physical performance levels were significantly lower in the longest QTc interval group compared to the shortest QTc interval group, especially, this relationship was observed in late-stage elderly group (p<0.05, respectively). These results suggest that decreased physical performance levels were also associated with prolonged QTc interval in elderly subjects.

This study examined whether physical and cognitive function was independently associated with risk of Musculoskeletal Ambulation Disorder Symptom Complex (MADS) in community-dwelling older people. We examined 640 older people (315 men, 325 women; 65–89 years). We assessed physical performance by one-leg standing with eyes open, timed up and go (TUG), muscle strength, muscle power, and gait speed. Cognition was assessed using Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), and Trail-Making Tests (TMT) A and B. We divided participants by physical function into “MADS” (one-leg standing < 15s or TUG ≥ 11s) and “non-MADS”, and identified cognitive impairment if MMSE was < 27 and CDR ≥ 0.5. We also grouped by sex and age (younger-old: 65–74 years and older-old: 75–89 years), and controlled for age, Body Mass Index, education and steps. Physical and cognitive function was significantly worse in the MADS groups. The younger-old men had poorer muscle strength, muscle power and TMT-A. The younger-old women had poorer muscle power, gait speed, MMSE and TMT-B. Older-old men had poorer muscle strength, and older-old women poorer gait speed (P < 0.05). The MADS groups also had significantly higher adjusted odds ratio (OR) for cognitive impairment (younger-old men: OR: 4.62; 95% confidence interval [CI]: 1.08–19.8; younger-old women: OR: 6.09; 95% CI: 1.03–35.9; P < 0.05). This study suggested that poorer physical and cognitive function was significantly associated with the risk of MADS, and these associations may be differ with sex and age.

We investigated the effects on medical education of early exposure of undergraduate students to a summer camp for children with asthma. An objective evaluation by the editorial staff found final improvements in the following areas (in descending order of frequency): learning of basic medical behavior (91% of students); cooperative attitude of medical staff in general treatment with the patient and the patient's family (88%); understanding of childhood growth and development (80%); knowledge of childhood asthma (69%); and mastery of basic techniques for therapy and examination (41%). The differences in the ratio of improvement (%) before and after visiting the camp, were (in descending order of frequency): cooperative attitude of medical care staff in general medical treatment with the patient and the patient's family (47%); understanding of childhood growth and development (45%); knowledge of childhood asthma (38%); learning of basic medical manner (34%); and mastery of basic techniques for therapy and examination (25%). These findings suggest that a summer camp is useful for exposing undergraduate medical students to children with asthma and is effective for helping them understand patients and family-oriented pediatric medicine.