Objective: To examine how best to provide information on over-the-counter (OTC) drugs in the future, the Japan Self-Medication Industry (JSMI) conducted an online survey on public attitudes toward changes in the system for controlling the sales of OTC drugs specified by the revised Pharmaceutical Affairs Act effective since June 2009.
Methods: A secure web-based questionnaire system was developed and linked to the JSMI website.  The survey was conducted between July 17 and August 31, 2009.
Results: Of the 4,257 people who responded to the questionnaire, 56.8% indicated they understood the provisions of the revised Pharmaceutical Affairs Act.  More than half of the responders had positive opinions of the revision.  They welcomed the improvement in convenience resulting from the availability of drugs at convenience stores, but “Druggists,” who are responsible for sales of the drugs, were not sufficiently represented among responders.  It was inferred that the general public feels that they should be able to purchase OTC drugs for self-medication after receiving sufficient information about the drugs from qualified sources.

　　Since February, 2012, Anjo Kosei Hospital has embarked upon a new scheme for efficiently handling narcotics during surgical operations. For the purpose pharmacists are allowed to enter the operating room for a while. At the same time, the implementation of digital record keeping for narcotics management tasks has started, making it possible to simplify the handling of a great number of patients. By reviewing the effects on narcotics handling and hours billed, we could determine the effectiveness of operating room pharmacist-led narcotics management at Anjo Kosei. Out of narcotics prescriptions (n＝647) handled in the operating room for one month, 84.7% (548/647) was accounted for by prepared narcotics and 99.8% (646/647) by post-operation management. The introduction of the digital record system resulted in a reduction from 53.3±9.6 minutes to 39.6±6.3 minutes for narcotics preparation, and a reduction from 66.8±16.1 minutes to 41.1±13.5 minutes for post-operation management (p<0.01). It has added to the work efficiency and simplification of operations. Moreover, due to the intervention of pharmacists in the operating room, 92.3% of narcotics prescriptions was performed using the new management system within a relatively short time (80.8±18.4minutes). These data show that the introduction of the new scheme has resulted in more efficient management of narcotics at Anjo Kosei.

We had previously reported a close association between pathological response and the maximum tumor standardized uptake value (SUVmax) measured by 18F-fluorodeoxyglucose positron emission tomography prior to chemotherapy in estrogen receptor (ER)-positive breast cancer. We hypothesized that glucose hypermetabolism by luminal B tumors may result in chemotherapy responsiveness. Using a single-gene expression assay, TargetPrint(R) (Agendia) and a 70-gene expression classifier, MammaPrint(R) (Agendia), we divided 20 patients with ER-positive primary breast cancer into luminal A and luminal B subtypes and compared the tumor SUVmax value between the two groups. A significantly higher SUVmax was measured for luminal B tumors (n=10; mean+/-SD, 7.6+/-5.6) than for luminal A tumors (n=10; mean+/-SD, 2.6+/-1.2; p=0.01). Glucose hypermetabolism could help predict intrinsic subtyping and chemotherapy responsiveness as a supplement to ER, progesterone receptor, HER2, and Ki-67 histochemical scores.
Breast ; Breast Neoplasms ; Estrogens ; Glucose ; Humans ; Phenobarbital ; Positron-Emission Tomography ; Receptors, Progesterone

PURPOSE: Since a patient's obesity can affect the mortality and morbidity of the surgery, less drastic surgeries may have a major benefit for obese individuals. This study evaluated the feasibility of performing a totally laparoscopic distal gastrectomy, with intracorporeal anastomosis, in obese patients suffering from gastric cancer. MATERIALS AND METHODS: This was a retrospective analysis of the 138 patients, who underwent a totally laparoscopic distal gastrectomy from April 2005 to March 2009, at the National Kyushu Cancer Center. The body mass index of 20 patients was > or =25, and in 118 patients, it was <25 kg/m2. RESULTS: The mean values of body mass index in the 2 groups were 27.3+/-2.2 and 21.4+/-2.3. Hypertension was significantly more frequent in the obese patients than in the non-obese patients. The intraoperative blood loss, duration of surgery, post-operative complication rate, post-operative hospital stay, and a number of retrieved lymph nodes were not significantly different between the two groups. CONCLUSIONS: Intracorporeal anastomosis seemed to have a benefit for obese individuals. Totally laparoscopic gastrectomy is, therefore, considered to be a safe and an effective modality for obese patients.
Body Mass Index ; Gastrectomy ; Humans ; Hypertension ; Laparoscopy ; Length of Stay ; Lymph Nodes ; Obesity ; Retrospective Studies ; Stomach Neoplasms ; Stress, Psychological

Purpose: This study was performed to evaluate the prognostic value of preoperative C-reactive protein to albumin ratio (CAR) in older patients with colorectal cancer (CRC) undergoing curative resection. Methods: We retrospectively analyzed 244 older patients (aged 75 years or higher) with pathological stage II or III CRC who underwent curative surgery between 2008 and 2016. The optimal value of CAR was calculated and its correlation with the clinicopathological factors and prognosis was examined. Results: The optimal cutoff value of the CAR was 0.085. High preoperative CAR was significantly associated with high carcinoembryonic antigen levels (P=0.001), larger tumor size (P<0.001), and pT factor (P=0.001). On multivariate analysis, high CAR was independent prognostic factor for relapse-free survival (P=0.042) and overall survival (P=0.001). Conclusion Preoperative elevated CAR could be considered as an adverse predictor of both relapse-free survival and overall survival in older patients with CRC undergoing curative surgery.

Information pertaining to self-regulated learning strategies for nurses in distance learning is scarce, There is also insufficient information regarding suitable learning support. We conducted a survey, exploring the demographic data and self-regulated learning strategies of 183 nurses who used distance learning; 159 nurses responded. In this study, nurses tended to use “asking peers” as their primary learning support. Additionally, “developing learning plans,” “devising learning methods,” and “reflecting on learning methods” showed a positive correlation. “Developing learning plans,” “devising learning methods,” and “rewarding oneself” also showed a positive correlation. Finally, a positive correlation was found between “asking peers” and “rewarding oneself.” A bulletin board for exchanging opinions among learners and the implementation of a pre-course were suggested as ways to support distance learning for nurses.

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.