In order to find an effective way to detect bacteria responsible for respiratory tract infections in children, we first examined as pharyngeal swabs, epi-pharyngeal swabs and nasal aspirates obtained from children hospitalized at our pediatric service during these five months from December 1997 to April 1998. In the rate of bacterial infection, it was found that nasal aspirates came out on top with 92.6%(25/27), followed by epipharyngeal swabs with 71.6%(53/74) and pharyngeal swabs with 26.2%(38/145). Single-species bacteria were found in 78.9%(30/38) of pharyngeal swabs, where as 45.3% of epi-pharyngeal swabs (24/53) and 52.0% of nasal aspirates (13/25) proved mixed infections with two-or three-defferent species. Thus it was suggested that nasal aspirates and epi-pharyngeal swabs would be far more adequate than pharyngeal swabs to detect bacteria with accuracy.
Next, based on the efficiency of bacterial detection, we compared culture media for the specimen obtained from in-patients and out-patients at our pediatric service. The rate of isolation of gram-negative rods was as low as 0.3%(1 of 314 strains) even when BTB agar plate, a selective medium for these bacteria, was employed. The sensitivety was not much different from those observed with nonselective blood agar plate. These results suggest that the conventional blood agar media can substitute for the more expensive type of BTB agar medium for the diagnosis of infections diseases of the airwaysin children.

Objective: There are only a few studies evaluating the effects of drug information services on pharmacotherapy.  We, therefore, studied the effects of providing drug information such as the effectiveness and safety of aliskiren on its pharmacotherapeutic efficacy by comparing before versus after drug information provision.
Methods: Pharmacists provided drug information such as the effectiveness and safety of aliskiren coadministered with either ACE-I (angiotensin converting enzyme inhibitor) or ARB (angiotensin receptor blocker) to physicians and other healthcare professionals.  We compared the number of patients for whom aliskiren was prescribed, the proportion of diabetic patients taking both aliskiren and ACE-I (or ARB), the proportion of patients with low eGFR (estimated glomerular filtration rate), and the proportion of patients with hyperkalemia and related conditions, before versus after providing the drug information to the healthcare professionals.
Results: The number of patients for whom aliskiren was prescribed decreased.  The proportion of patients taking both aliskiren and ACE-I (or ARB) decreased significantly after providing the drug information (p=0.007).  The proportion of diabetic patients taking both aliskiren and ACE-I (or ARB), the proportion of patients with low eGFR, and the proportion of patients with hyperkalemia also decreased, after providing the drug information.
Conclusion: This study showed the drug information service to be clinically beneficial, achieving better pharmacotherapy.  Pharmacists should evaluate and provide information on the effectiveness and safety of drugs announced by authorities in a timely manner to achieve optimal patient care.

We described a patient with free wall rupture followed by papillary muscle rupture due to acute myocardial infarction. A 69-year-old man was transferred complaining of transient unconsciousness. His clinical history, electrocardiogram, and chest CT showed myocardial infarction with free wall rupture indicated that several days had passed since the onset. Coronary angiography showed occlusion of the right coronary artery and severe stenosis of the left anterior descending artery. Since cardiac rupture was at inferior wall and hemorrhage wasn't active, repair of the rupture using fibrin glue and fibrin sheet and coronary artery bypass grafting to the left anterior descending artery was performed without cardiopulmonary bypass. On the 10th postoperative day, his arterial oxygen saturation suddenly deteriorated. Transesophageal echocardiography revealed papillary muscle rupture and severe mitral regurgitation. Emergency mitral valve replacement was performed. After two emergency operations, he gradually recovered and were discharged to home. In three months after discharge, he was admitted again due to congestive heart failure with left ventricular aneurysm at inferior wall and recovered in response of conservative treatment. Surgical experience of double rupture is rare. Based on this case, it may be necessary to perform reperfusion therapy toward even this case of recent myocardial infarction, to prevent papillary muscle rupture. It also may be better to use a patch on free wall rupture to prevent cardiac aneurysm.

Purpose：This study investigated the current state of medical care and home palliative care for terminally ill cancer patients in Japan. Methods：We conducted a retrospective questionnaire study of 352 cancer patients who received home palliative care from 6 specialized home care clinics and discontinued home care or died from January to June in 2012. Results：The questionnaire was answered by 290 patients〔165 men（57％）, mean age：72±13 years〕who started home palliative care after completing cancer treatment. Home visits from nurses were used by 238 patients（98％）and 95 patients（39％）used home care workers. Within a month before discontinuation of home care or death, 72 patients（30％）received fluid therapy and 127 patients（52％）received strong opioids. The outcome of home palliative care was death at home in 242 patients（83％）and discontinuation of home care in 48 patients（17％）. The reason for discontinuation was family physical and mental problems or physical problems of the patient. Conclusion：This study demonstrated the current state of home palliative care by specialized home care clinics.

Objectives:To determine the factors influencing death or the cessation of palliative care in home-based setting among patients with cancer. Methods:We included 352 terminally ill patients with cancer who received home-based palliative care from six specialized palliative care clinics. We reviewed the medical charts when patients died at home or chose to stop home care. Results:A total of 82％ of participants died at home, and 18％ chose to stop home care. Multiple logistic regression analysis revealed five independent factors that affected cessation of home-based palliative care:patient and informal caregiver preferences for the place of death not to be at home［odds ratio, 10.1（95％ Confidential interval, 2.5-40.9）and 51.9（11.9-226.6）, respectively］or uncertain preferences［5.0（1.3-19.4）, 10.8（2.3-50.5）］;anxiety and depression among informal caregiver［4.1（1.2-13.9）］;lower frequency of informal care［6.8（2.0-23.4）］;and history of admittance to hospital during home care［11.6（4.0-33.9）］. Conclusion:We revealed independent factors influencing death or the cessation of palliative care in home-based settings among patients with cancer. Our findings suggest the importance of providing support for decision making about the place of death and hospital admission, and psychosocial support for informal caregiver to ensure home death consistent with patient preference.

Purpose: This study investigated the current state of critical hemorrhage during home palliative care for terminally ill cancer patients. Methods: We conducted a retrospective medical chart review of 7 cancer patients (1.4%) who received home palliative care from our clinic and died of critical hemorrhage at home from October 2007 to December 2014. Results: Four patients were male, the mean age was 70±11 years, and underlying diseases were different. None of the patients were accompanied by medical staff at the onset of bleeding. Six patients died at home and one patient was admitted to hospital for hemostasis. Six patients had a pre-hemorrhage episode more than 24 hours before critical hemorrhage occurred from the same site. One patient was administered a hemostatic agent, hemostasis was attempted in one, and one was given sedation. Six patients wanted to die at home, and did die at home. Discussion: If terminally ill cancer patients have critical hemorrhage at home, our options are limited. The results of this study suggest the importance of hemorrhage risk assessment and advance care planning.

Background / Purpose: The aim of this study was to analyze the relationship between metacognition and mental health among first-year Japanese medical students at several months after admission.　Method: A questionnaire survey was conducted on first-year medical students at a private medical university. We used the Adults' Metacognition Scale to measure metacognition and the Japanese version of the 12-item General Health Questionnaire (GHQ-12) to measure mental health status.　Results: The data from 80 students were analyzed. The total metacognition score and the subscale monitoring score were negatively correlated with the GHQ-12 total score and were significantly different between the poor mental health group and the good mental health group. 　Discussion: The results suggest that students in poor mental health status were considered to have weak metacognition, especially monitoring.

This paper proposes a method for evaluating and scoring the activities of rehabilitation service users in order to pinpoint the problems with the health service of this kind and set the adequate targets for each user. Sincs the Nursing Care Insurance System was introduced in Japan in 2000, it has been argued that home-visit rehabilitation services should be excluded from home-nursing care services. However, the methods of certifing that nursing care is required are not fully established yet for setting the rehabilitation targets for service users. As things stand, it is recommended that such a method as the Functional Independence Measure (FIM) or the Barthel Index (BI) should be utilized. However, these methods only evaluate “performing activities” (the activities that a user usually performs). In order to set the users' targets, we thought it necessary to establish a method for evaluating “possible activities” (the activities that a user is able to perform at his/her full capacity). We have established a method called Functional Scoring (FS) which evaluates and scores the both performing and possible activities based on the same evaluation items. We conducted experimental evaluations on the home-visit rehabilitation users for one year from October 2005 to September 2006. When the first evaluations in 2005 were compared with the second evaluations in 2006, the total score of the performing activities significantly increased from 44.1±13.7 to 47.8±14.2 (P<0.05). Although the total score of the possible activities did not significantly increase, it demonstrated an upward trend from 49.6±13.2 to 51.6±13.5. The result suggests that our method is useful for distinguishing between the performing and possible activities. The proposed method enables us to adequately recognize the problems each user has, and to set the rehabilitation target for each user, which can be shared between the user, care personnel, and care service provider.
Rehabilitation aspects ; Functional ; FS ; Care given by nurses ; Published Comment