The present study aimed to investigate how nutritional status affected iron status, and how this knowledge might be used to prevent anemia in rhythmic gymnasts prior to a competition. We divided twenty-one subjects according to their iron status in just prior to competition into either an iron-deficiency group (n=12) and a non-iron-deficiency group (n=9), the latter of which represented the normal group. Iron-deficiency group was defined as a hemoglobin concentration below 12g/dl, a ferritin level below 12ng/ml and/or a transferrin saturation ratio under 16%. Physical, hematological, and nutritional assessments were made using a semi-quantitative food frequency questionnaire, once at 2 months before a competition, and once more just prior to the competition (‘pre-competition’).1) The iron-deficiency group had significantly lower body weight, body mass index and body fat at pre-competition compared to 2 months before the competition.2) Compared to the normal group, the iron-deficiency group had significantly lower serum iron and haptoglobin concentrations at the pre-competition.3) Intakes of energy, protein, iron, and vitamin C at the pre-competition were 1965±340kcal, 68.0±14.0g, 11.2±3.2mg, and 76±30mg in the normal group, and 1620±456kcal, 53.8±18.0g, 11.6±4.1mg, and 75±29mg in the iron-deficiency group, respectively. There was no significant difference in intakes of energy, protein, iron, and vitamin C between the groups, respectively.4) Pre-competition protein intakes per body weight (BW) were 1.46±0.33g and 1.08±0.31g in the normal group and the iron-deficiency group, respectively. Those levels were significantly lower in the iron-deficiency group than those in the normal group.5) Pre-competition protein energy ratio (13.9±1.6%) and animal protein ratio (56.0±6.7%) of the normal group were significantly higher than those measured 2 months before the competition. Conversely, those ratios remained constant for 2 months in the iron-deficiency group.6) Changes in the protein energy ratio and/or the animal protein ratio between the pre-competition and the 2 months before were significantly correlated with the pre-competition Hb levels.We conclude that the pre-competition iron status is closely associated with protein intakes in female collegiate rhythmic gymnasts.

　　In the guidance of technical aspects in the “new nursing staff training guidelines” prepared by the Ministry of Health, Labor and Welfare in December 2009, We were using an e-learning method. We evaluated the achievement of nursing technology item 69 and examined the problems to be solved for the future basic nursing technical guidance. The subjects in the present study were 53 persons who joined the of rookie nursing staff of our hospital in April 2013 (new nurses are all fresh from college). Of the goals indicated in the guidelines, nursing technology item 69 was prepared for the group training course using e-learning. The trainees learned with a focus on simulation. After that each department carried out OJT and evaluation. 　　We aggregated achievement evaluations and carried out questionnaire surveys on the use of e-learning in June, September and March of the following year. We compared and examined the evaluations of achievement in comparison with the previous year evaluations. In March 2014 when the new nursing staff training program ended, it was found that those who attained “a measure of reach 1: can” or “2: as possible under the guidance” accounted for 36.5% of the total number of recruits in 2013, compared to 34.9% in 2012. The ratio of those who highly evaluated “a measure of reach 4: have knowledge” remarkably increased from4.5% to23.4%, and that of inexperienced persons or people who did not evaluate decreased from 29.2% to 4.2%. This showed that the self-learning and utilizing e-learning at their own pace proactively helped them to acquire basic nursing skills. However, a problem remained that too much time was required for evaluation, because it has been actually evaluated over 100 fields due to detailed e-learning items, the limited number of desk-top computers.

Introduction: The purpose of this study was to clarify factors related to recognition of the possibility of end-of-life care at home (hereafter referred to as end-of-life care) among middle-aged and elderly people living in heavy snowfall and depopulated areas.Methods: Residents aged 40~69 years in town B, prefecture A were surveyed by mail using a self-administered, unmarked questionnaire. Analysis methods were: (1) a reliability analysis of survey items, (2) basic statistics, (3) tests for differences in composition ratios, (4) tests of differences between the two groups for each item, and (5) binomial logistic regression analysis. Recognition of the possibility of end-of-life care was used as the objective variable, and sex, age, and 18 indicators significant in (3) and (4) were used as explanatory variables.Results: There were 63 in the positive group for end-of-life care, 239 in the negative group, and 120 in the unknown group (Response rate: 44.1%). Factors related to perception of the possibility of end-of-life care were positively related to "existence of a community hospital, " "positive image of end-of-life care, " and "trust in people in the community. "Conclusion: In depopulated areas, it is necessary to consider specific measures to promote the three factors that raise awareness of the possibility of end-of-life care.

Purpose: The present study aims to evaluate the effect of analgesics in cancer patients based on their pain descriptions. Methods: The relationship between the words that patients used to describe their pain due to cancer and the efficacy of treatment with analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids was evaluated. Results: We recorded 529words that were used by 164patients to describe their pain and pain quality and classified them into 108types of pain.For patients who used the actual word 'dull' or one with a similar meaning, treatment with opioids was effective. However, treatment with opioids was less effective in patients who used words such as "numb" and "tingling". Conclusion: We were able to gain a good understanding of cancer pain by listening to the actual words that patients used when complaining of pain. These findings suggested that we could choose a suitable medication through evaluation of the actual words cancer patients used to describe their pain and successfully relieve their pain. Palliat Care Res 2009: 4(1): 207-213

BACKGROUND: Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported. METHODS: A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation. RESULTS: Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL;P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 μIU/mL) were higher than at admission (1.48±0.5 μIU/mL) in group C (P<0.05). CONCLUSION: Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.

A 71-year-old woman with a history of closed commissurotomy for mitral valve stenosis 44 year ago, was diagnosed with left ventricular aneurysm by transthoracic echocardiography. She had no symptom of left ventricular aneurysm. Since there was a high risk of left ventricular rupture, we decided to undertake surgical treatment. During the surgery, we found artificial material near the left ventricular aneurysm. We resected the aneurysm wall and closed the ventricular wall using felt strip reinforcement. The wall of the aneurysm had no myocardium upon pathological examination. We diagnosed that it was a left ventricular pseudoaneurysm, and it seemed to be formed by blood oozing from the apical repair point of the hole for the dilator to perform mitral valvulotomy. The postoperative course was uneventful and she was discharged on postoperative day 20. Left ventricular pseudoaneurysm often results after myocardial infarction, and reports after cardiac surgery are rare, except in cases after mitral valve replacement. We hereby report our experience with this rare case