Objective: Many of the elderly patients are suffering from constipation, are using the oral laxative.  However the risk assessment of the oral laxative is not performed.  Therefore, we used Japanese Adverse Drug Event Report database (JADER) and examined for the safety of the oral laxative in the elderly patients.
Methods: Since the analysis target medicines; 12 oral laxatives and target ADEs; “digestive disorders” and “electrolyte abnormality,” the JADER database for April 2004 to January 2015 were analyzed in adults of age exceeds 60.  We used the reporting odds ratio for a safety index of drugs, using reporting odds ratio, when the Lower bound of the 95% two-sided confidence interval exceeds 1, it is the signal detection of ADE.
Results: The oral laxatives detected the signal of “digestive disorders” were three medicines, and “electrolyte abnormality” were five medicines.  Especially, for electrolyte abnormalities not only increases the blood magnesium values as magnesium oxide, that there is also affect other electrolyte revealed.
Conclusion: Some oral laxatives were also intended to signal detections of the adverse events that are not listed in the attached document, it is necessary to pay attention to the use of them for the elderly patients.

Objective: Elderly patients commonly experience adverse drug events (ADEs) owing to their poor drug metabolizing and excretion ability, and these often cause multiple organ dysfunction syndrome.  Therefore, it is important that we identify the adverse drug events early on during prognosis.  We searched for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.
Methods: The objects under analysis were oral medicines that were registered in the Japanese Adverse Drug Event Report database (JADER).  The associations between the elderly/non-elderly patients and exacerbation risk/non-exacerbation risk were analyzed by risk ratios (RR).  The signal detection of exacerbation risk was defined as 95% confidence interval of lower limit of risk ratio>1 and χ²≥4.
Results: The oral medicines that might markedly exacerbate the prognosis of ADEs in the elderly patients in comparison with the ADEs of young patients included 84 items, of which 63 have not been described as potentially inappropriate medicines in all guidelines for medical treatment of the elderly patients.
Conclusion: In this study, while we could not search for oral medicines having a high risk of ADEs, we were able to search for oral medicines that might exacerbate the prognosis of ADEs in elderly patients.  This result could contribute to the proper use of medicines in the elderly patients.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
Activities of Daily Living ; Asian Continental Ancestry Group* ; Baths ; Humans ; Mortality ; Neoplasm Metastasis* ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome

A 31-year-old woman infected with severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) at 33-weeks pregnant was subject to cesarean delivery due to a worsening respiratory condition. On the fourth day of illness, the patient was placed on a ventilator, with extracorporeal membrane oxygenation (ECMO) treatment initiated on the ninth day. Passive range of motion (ROM) training started on the day 33 of illness. She was weaned off ECMO on day 55 of illness and taken off of the ventilator on day 8. The tracheostomy tube was replaced with a speech cannula on day 87 of illness, at which time the patient began to complain of pain during passive ROM training. Plain X-ray photography and computed tomography (CT) showed ossification around the bilateral shoulder and hip joints, as well as on medial thighs, accompanied by an alkaline phosphatase (ALP) value of 942 U/L. She was subsequently diagnosed with heterotopic ossification, after which passive ROM training was changed to protective ROM training, in addition to treatment with indomethacin farnesyl and etidronate disodium. The patient was transferred to our hospital on day 122 of illness for the purpose of continuing rehabilitation. On day 155 of illness, ossification decreased on the medial thighs, according to CT. She was able to walk independently indoors and was discharged home on day 181 of illness. This case demonstrates the importance of checking the ALP levels and palpating the periarticular area in patients infected with SARS‑CoV‑2 before initiating passive ROM training, as well as being aware of any pain experienced during training. In the case of any abnormalities, assessing the ossification around the joints of extremities by imaging examination is a priority.