Purpose: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. Methods: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. Results: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. Conclusion: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126

1）Palliative care education by means e–learning was performed from December 3 to 25, 2009, for 1256 hospital medical staff. We used the same true–or–false questions to assess their understanding before and after the e–learning course.
2）Regardless of the staff member’s experience, the total scores on the test were higher after the course than before the course. Therefore, this e–learning course had an effect on basic knowledge for multiple types of medical staff.
3）The percentage of correct answers was particularly improved for questions about topics we had emphasized: drug dependence and side effects.

We report a case of redo mitral valve replacement (MVR) for a Björk-Shiley Delrin valve implanted 47 years previously. A 71-year-old man initially underwent MVR for mitral regurgitation at our hospital at the age of 16 years. Following the operation, follow-up examinations were performed at the outpatient clinic and annual transthoracic echocardiogram findings showed only mild mitral regurgitation, with no adverse events noted. However, a transthoracic echocardiogram examination performed 45 years after the operation revealed mild to moderate mitral regurgitation, while dyspnea with exertion was also noted at that time. As part of a more detailed examination, transesophageal echocardiogram results showed moderate transvalvular leakage. Redo MVR was subsequently performed under the diagnosis of prosthetic valve dysfunction. Analysis of the explanted prosthetic valve revealed wear of the Delrin disk, and widening of the gap between the disk and strut, which were presumed to be the cause of transvalvular leakage. A half century has passed since introduction of the Björk-Shiley valve and the present is a rare case of valve malfunction. Presented here are related details, along with a review of existing literature and results of Björk-Shiley valve use at our hospital.

BACKGROUND: We investigated the association between psychological distress and oral health status/oral health-related quality of life (OHQoL) in Japanese community-dwelling people. METHODS: We conducted a cross-sectional study using data from the Nagasaki Islands Study. A total of 1183 (455 men and 728 women) has been analyzed in this study. Psychological distress was measured using the Kessler Psychological Distress Scale (K6). Oral health status was measured by dental examination. The OHQoL was measured using the General Oral Health Assessment Index (GOHAI). We defined the total score of ≥5 points on the K6 as high psychological distress (high-K6 group). RESULTS: The multiple linear regression analysis to identify the GOHAI showed that gender, K6, the total number of teeth, the number of dental caries, and visiting a dental clinic within the past 6 months significantly associated with the GOHAI. Among all of these variables, high-K6 (≥ 5) was a substantial contributing factor of the GOHAI (β = - 0.23, 95% Cl - 2.31 to -1.41, p < 0.0001). CONCLUSIONS It is likely that the individual with high psychological distress was strongly related to poor OHQoL even in the general population.
Aged ; Cross-Sectional Studies ; Dental Caries/epidemiology* ; Female ; Humans ; Independent Living/statistics & numerical data* ; Japan/epidemiology* ; Linear Models ; Male ; Middle Aged ; Oral Health/statistics & numerical data* ; Quality of Life/psychology* ; Sex Factors ; Stress, Psychological/epidemiology*