Purpose: Approximately 30% of the patients who received intervention from a palliative care team for problematic symptoms (e.g., pain, nausea, depression) also underwent rehabilitation at our acute hospital. We investigated their changes in activities of daily living (ADLs) and outcomes (i.e., death, changing hospitals, or being discharged to their homes). Method: We retrospectively analyzed the patients’ medical records data to examine patient training content, Barthel Index (B.I.) scores, and outcomes. Results: For one year, 86 patients received rehabilitation and 42 (48%) underwent anticancer therapy. B.I. scores increased for 35% of the patients, were stable for 20%, and decreased for 45%; 95% of the patients with decreased B.I. scores could not be discharged home. Conclusion: Advanced cancer patients are likely to experience a decline in ADLs and require longer rehabilitation periods to improve. A team approach is important for preventing disuse syndromes within a palliative care setting.

　　Urinary tract infections (UTIs) are among the most common entities in hospitals, accounting for about 40% of nosocomial infections. It is said that more than 80% of UTIs are associated with the use of catheters. The discharge opening of the Uro Bag, a type of urine storing bag, is alive with bacteria. The microorganisms can enter the bag and then bladder, causing UTIs. It can also be said that the longer the catheters are used, the greater the risk of catheter-related UTIs becomes. Furthermore, Pseudomonas aeruginosa, Staphylococcus aureas, Serratia mareescensand other kinds of bacteria that have acquired the resistance to drugs are increasing. The incidence of mixed infections with different organisms are on the rise. Such being the present situation, to prevent UTIS we think that the proper management of urinary catheterization and right use of urethral catheters are of the primary importance. Those health providers who handle catheters frequently need to take every precaution against inadvertently acting as intermediaries in the incidence of nosocomial infectious diseases including catheter-related UTIs. Recently, we reviewed the prophylactic measures which had been taken by our hospital, assessed the findings using the checklist made by the Nosocomial Infection Prevention Committee. Later, we held a seminar and discussed the standardization of prophylactic measures. As a result, the assessment items which were rated low in June marked 100% in September and March. Thus, our efforts have led the hospital employees to deepen their knowledge and understanding of the need to watch out nosocomial infection constantly. For the guidance of employees, we included in the educational program on-the-job training, which proved to be helpful for the trainees to have imagery. To maintain the effect of infection prevention and to keep up the interest awakened in the hospital staff, the holding of seminars and meetings for reviewing on a regular basis are called for.

A sixteen-year-old girl with neuropsychological dysfunction after cerebral encephalopathy came to our hospital for evaluation of her cognitive impairment and ability to acquire compensatory skills for communicative dysfunction. Neuropsychological examinations revealed low scores on FSIQ, VCI, WMI and PSI by WISC-Ⅳ. We intervened using a process-orientated speech-language-hearing therapy to improve her cognitive, language and communicative skills for a year. After that, we evaluated her cognitive ability by WISC-Ⅳ and LCSA. As a result of our intervention, her word knowledge, idiom and mental expression, sentence expression and reading social condition and expression scores in LCSA performance were improved but each IQ by WISC-Ⅳ was preserved. In ST intervention for pediatric neuropsychological dysfunction, the patient evaluation should be made not only using IQ by WISC-IV but also by measuring other communicative skills such as by LCSA.

Small groups of 5th-year medical students performed a survey of hospital patient services in hygiene and public health, with an emphasis on patient waiting time. The purpose of this course was to give medical students the opportunity to experience the waiting time endured by patients and to obtain some understanding of the quality of hospital services from the patient's point of view. The survey was performed as follows. Groups of five students accompanied new patients in the department of internal medicine from registration until payment. The students recorded waiting time and examination time. During the waiting time, the students asked the patient questions to evaluate service. Patients were cooperative in giving responses during the survey. After the survey, the students summary proposed how to improve services for patients. By accompanying and talking with patients, the medical students were able to understand hospital systems from the patient's point of view. This course should prove useful for these students future careers in medicine.

A whole body indirect calorimeter provides accurate measurement of energy expenditure and the respiration quotient over long periods of time, but has limitations to assess dynamic changes in energy metabolism due to the small amplitude of the signal in relation to the size of the room. The present study aimed to improve algorithm for the whole body indirect calorimetry by adopting a deconvolution with a regularization parameter. Performance of the new algorithm was compared with trends identification (Med. & Biol. Eng. & Comput 34 : 212, 1996) against four validation tests. In a simulated problem, in which metabolic rate cycled with a period of 20 min, mean square errors (MSEs) computed at every 1 min by the deconvolution (0.0036 for O₂ consumption and 0.0017 for CO₂ production) were smaller than those for trends identification algorithms (0.0198 and 0.0142). Deconvolution algorithm clearly separated individual CO₂ infusion of 8 min intervals, while trends identification could no longer separate them. During the validation by ethanol combustion, which produced a near-steady state condition, the deconvolution (MSEs were 0.0022 for O₂ consumption and 0.0010 for CO₂ production) performed better than trends identification algorithms (MSEs were 0.0086 and 0.0041). When validated against direct measurement of gas production rate during non-steady state condition, produced by a human subject intermittently exercising in the calorimeter, deconvolution (MSEs were 0.0032 for O₂ consumption and 0.0038 for CO₂ production) performed better than trends identification algorithms (0.0182 and 0.0167). The new algorithm significantly improved transient response of the whole body indirect calorimeter.

Background: The aim of this study was to clarify the decadal trends in the structure and usage status of palliative care units in Japan and the association with length of stay. Methods: We conducted a secondary analysis of data from nationwide surveys of palliative care units conducted by Hospice Palliative Care Japan from 2002 to 2012. Length of stay was divided into three categories (within 30 days, 31 to 60 days, and 61 days or more). Results: Significant decadal trends in usage status were observed: the mean annual number of admitted patients (119±55 persons in 2001, 163.0±77.7 in 2011, p＜0.001), and deaths (99±44, 136±58, p＜0.001) increased and the mean length of stay in a palliative care unit (8±15 days, 39±15, p＜0.001) decreased. Palliative care units with a shorter mean length of stay had significantly more admitted patients, and more discharged patients, and a significantly lower mean ratio of death to discharge, and a lower bed availability rate. In contrast, length of stay was not significantly associated with the structure of palliative care units, including the type of units, number of inpatient beds, percentage of private rooms, and number of staff. Conclusion: The features of decadal trends in the structure and usage status of palliative care units in Japan were a shortening of length of stay, and an increase in the number of patients. Palliative care units with a shorter mean length of stay cared for a larger number of terminally ill patients.

We report a case of ulcerative colitis (UC) after mitral valve replacement (MVR) surgery due to infective endocarditis (IE). A 59-year-old woman underwent MVR for mitral regurgitation due to IE. Six days after the surgery, melena was observed suddenly, and she received a blood transfusion. Ulcer and erosion were observed in the rectum 5 to 10 cm from the anal ring by endoscopy. We changed her antibiotic treatment and stopped warfarin potassium. Heparin sodium was started 2 days after melena. We diagnosed ulcerative colitis from the finding of the rectal lesion and biopsy. We gave mesalazine and betamethasone as treatment for UC. The patient's condition improved and her general condition stabilized. She was discharged 36 days after surgery.

　　With the aim of revamping hospital service as a pillar of our hospital reform movement, the Service Training Committee came into being in 2012.　　A questionnaire survey was conducted on the entire personnel and tenant suppliers (the entire personnel, tenants and contractors’ employees?). About 80% (705 people) of those queried replied. More than 90% of the respondents were of the view that an improvement in the manner of reception should enhance not only the prestige of the hospital, the evaluation its medical treatment and patients&rsauo; degree of satisfaction, but also hospital employees’ degree of satisfaction and their quality of life.　　On the other hand, some respondents said that there was much to be desired in the way hospital employees exchange greetings with their colleagues and in the manners or the language they use when they speak to patients.　　Most of the hospital staff seemed to understand the importance and meaning of service and hospitality very well. It was clear that the hospital employees were willing to join in our drive to improve the quality of service. They also understood the problems they should address to in earnest.　　We thought it was our task to make use of their positive attitude toward the quality improvement of service. What we have in view is to create a hospital culture that makes it seem natural to provide a high-quality service to visitors and patients. To this end, we will develop various activities and hold workshops.

Objective: This study aimed to assess gynecologic oncologists (GOs)’ perceptions and attitudes toward cancer survivorship to help improve survivor care. Methods: We conducted a web-based questionnaire survey about survivorship issues for the GOs belonging to the Japan Gynecologic Oncology Group. We analyzed the proactiveness of the participants toward addressing 25 survivor issues. In addition, the practice patterns and barriers to care for survivors’ long-term health issues, such as second primary cancer (SPC) and lifestyle-related diseases (LSRD), and return-to-work (RTW) support were assessed. Results: We received 313 responses. The respondents had a mean of 22 years of physician experience. The ratio of men to women was approximately 7:3, and 84.7% worked at facilities for multidisciplinary cancer treatment. The respondents’ proactiveness for addressing psychosocial problems was significantly lower than physical and gynecological issues (p<0.01 by χ2 test). However, most GOs tried to contribute to such issues according to patients’ demands. Women GOs were more proactively involved in some survivorship issues than the men (p<0.05 by logistic regression analysis). The rates of the respondents who proactively discussed SPC, LSRD, and RTW were unexpectedly high (60.7%, 36.1%, and 52.4%, respectively). However, the GOs only provided verbal support for these issues in many cases. Conclusion The Japanese GOs were enthusiastic about survivorship care. However, their tendency to deal with survivors’ problems through their own knowledge and judgments raises concerns about the quality of care. Therefore, creating survivorship care guidelines and enhancing multidisciplinary collaboration should be prioritized.