The purpose of the present study is to investigate protein metabolism during rapid weight reduction. Six male boxing players put on a restricted diet of their own accord for two weeks. Body weight changes were observed and a biochemical analysis was made of their urine and blood. The initial body weight of 66.1±3.0kg (mean±SE) decreased to 63.6±3.2 kg after two weeks (P<0.01) . The changes in lean body mass (LBM) by weight reduction were not significant, but the LBM tended to decrease after two weeks. The mean caloric intake was 2, 791±728 kcal before the study and 1, 643±548 kcal after two weeks. The reduction of carbohydrate consumption is much more than that of fat and protein consumption. The 3-Me/Cr in urine increased significantly after two weeks (348.1 ± 37.0 μol/g to 508.1 f 45.6 μmol/g, P<0.01) and the increase of Urea-N/Cr in urine (8.4±0.5mg/mg creatinine to 13.7±1.3mg/mg creatinine, P<0.01) was also significant after two weeks. Urine volume decreased significantly after two weeks (P<0.01) . There was no significant difference in the blood components during the weight reduction period. These results might suggest that rapid weight reduction and massive decrease of carbohydrate intake accelerate protein catabolism.

Introduction : Intravenous rt-PA therapy for acute ischemic stroke patients within 4.5 hours after onset is approved and effective, but is difficult to implement in depopulated areas because of geographical conditions and lack of medical specialists.
Methods : From February 2013 to February 2014, 75 acute ischemic stroke patients were transferred to our hospital, four (5.3%) of which were subjected to the “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support). We examined the time course after onset and the treatment outcome of these four cases
Results : Four cases had rt-PA infusion started in the depopulated area. ln one case, recanalization of occluded vessels was demonstrated resulting in improved clinical symptoms.
Conclusion : The “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support) may be a safe and ideal treatment in depopulated areas.

The present study aimed to investigate how nutritional status affected iron status, and how this knowledge might be used to prevent anemia in rhythmic gymnasts prior to a competition. We divided twenty-one subjects according to their iron status in just prior to competition into either an iron-deficiency group (n=12) and a non-iron-deficiency group (n=9), the latter of which represented the normal group. Iron-deficiency group was defined as a hemoglobin concentration below 12g/dl, a ferritin level below 12ng/ml and/or a transferrin saturation ratio under 16%. Physical, hematological, and nutritional assessments were made using a semi-quantitative food frequency questionnaire, once at 2 months before a competition, and once more just prior to the competition (‘pre-competition’).1) The iron-deficiency group had significantly lower body weight, body mass index and body fat at pre-competition compared to 2 months before the competition.2) Compared to the normal group, the iron-deficiency group had significantly lower serum iron and haptoglobin concentrations at the pre-competition.3) Intakes of energy, protein, iron, and vitamin C at the pre-competition were 1965±340kcal, 68.0±14.0g, 11.2±3.2mg, and 76±30mg in the normal group, and 1620±456kcal, 53.8±18.0g, 11.6±4.1mg, and 75±29mg in the iron-deficiency group, respectively. There was no significant difference in intakes of energy, protein, iron, and vitamin C between the groups, respectively.4) Pre-competition protein intakes per body weight (BW) were 1.46±0.33g and 1.08±0.31g in the normal group and the iron-deficiency group, respectively. Those levels were significantly lower in the iron-deficiency group than those in the normal group.5) Pre-competition protein energy ratio (13.9±1.6%) and animal protein ratio (56.0±6.7%) of the normal group were significantly higher than those measured 2 months before the competition. Conversely, those ratios remained constant for 2 months in the iron-deficiency group.6) Changes in the protein energy ratio and/or the animal protein ratio between the pre-competition and the 2 months before were significantly correlated with the pre-competition Hb levels.We conclude that the pre-competition iron status is closely associated with protein intakes in female collegiate rhythmic gymnasts.

Purpose: The review of the published reports was performed with the aim of systematic collection and integration of information related to "signs and symptoms" along with their changes among patients after upper gastroesophageal surgeries. Methods: The PubMed and the Japanese healthcare literature database were searched by the following keywords:"gastric cancer" "esopha∗ cancer" "surgery" and "symptom" As a result, 37 articles related to gastric or esophagus cancer were identified. The data were extracted according to each sign and symptom, and were evaluated and discussed. Results and Conclution: Standardized instruments for gastrointestinal symptoms included evaluations about dysphagia, difficulty in swallowing, reflux etc. The incidence of signs and symptoms, or postsurgical recovery processes are different among individual patients. Healthcare professionals should support patients continuously and systematically so that patients can take appropriate health maintenance behavior according to their signs and symptoms.

BACKGROUND : Electronic medical records (EMRs) were first introduced in the 1960s, and in Japan they are starting to become popular. Recognizing the need to adapt to a new clinical setting with EMRs, we aimed to explore which interviewing skills were associated with patient satisfaction in this era of EMR use.
METHODS : A prospective observational study was conducted to evaluate interviewing skills among medical residents and to collate data on patients' satisfaction levels at an outpatient general medicine walk-in clinic at a teaching hospital in Japan. Five trained raters reviewed the video recordings of these interviews and assessed them based on a predetermined set of criteria for medical interview skills developed specifically for an outpatient EMR setting. The relationships between these assessment scores and patient satisfaction levels were analyzed.
RESULTS : Significant skills that were associated with higher scores of patient satisfaction included : employed appropriate eye contact (P=0.021) ; and, invited patients directly without using a microphone (P=0.008). In addition, the degree of keyboard typing during interviews was not associated with patient satisfaction.
CONCLUSIONS : In an outpatient setting with EMR, using good non-verbal communication skills to build trustful relationships with patients is more likely to influence patient satisfaction levels. Even when physicians are typing on a keyboard, if they keep appropriate eye contact during medical interviews, patient satisfaction can be improved.

Objective: We conducted a questionnaire survey to comprehend the situation regarding the collection, provision, and utilization of drug safety information at hospitals.  In addition, we asked pharmaceutical companies how they select medical institutions to provide drug safety information.  We also investigated the current situation of information provision to Tokyo Medial Center by pharmaceutical companies.
Method: A questionnaire was mailed to all hospitals in Japan.  The survey was conducted between January 13 and February 10, 2011.  Moreover, we asked thirteen pharmaceutical companies by telephone and e-mail about the implementation status of the provision of information and performed a survey at Tokyo Medical Center on the current situation of information provision by pharmaceutical companies regarding revisions to precaution sections in package inserts.
Results: The results of the questionnaire survey (response rate: 41.2%) showed that the major information sources for hospitals were medical representatives (77.8%), Drug Safety Update (50.3%) and direct mails (49.3%).  Furthermore, in the case of drugs prescribed exclusively for extramural dispensing, fewer hospitals responded that medical representatives of the pharmaceutical companies provided drug safety information and more hospitals responded that they did not obtain any drug safety information at all, compared with drugs listed in the hospital formularies.
Conclusion: To minimize the risks of drugs, healthcare professionals must collect a wide range of drug safety information and must utilize this information in their medical practice.  Therefore, it is important that pharmaceutical companies and regulatory authorities make an effort to provide suitable information dissemination to medical institutions.  Furthermore, medical institutions must also strengthen their systems for collecting drug safety information and providing such information to healthcare professionals.

Objectives: To reveal nursing competence acquired by nursing students via role-playing (RP) exercises and define the learning points necessary for acquiring practical nursing skills.Methods: Qualitative content analysis was performed using debriefing sheets (DSs) for adult nursing RP. There were 109 participants.Results: The DSs of 69 individuals who met the selection criteria were used as base data, and 1179 data items were extracted. The results showed that the structure included 3 main themes, 8 subthemes, 31 categories, and 121 subcategories.Conclusion: The results indicated that participants noticed the underlying elements that make up practical nursing skills, analyzed them using advance organizers based on previously learned knowledge, and applied the acquired practical nursing skills to newly proposed strategies for continuous self-management for adult patients with chronic disease and their families. One aspect of nursing competence, "ability to improve nursing quality," could not be extracted; the elucidation of this acquisition process is a task for future research.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.

Objectives: Radon (222Rn) is a noble gas found in the water of hot spring spas (“onsen”). In Japan, the Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised) classify springs containing 74 Bq/kg of radon as “hot springs” and those with levels exceeding 111 Bq/kg as “medical springs”, also called “radioactive springs”. According to the notification article (the Nature Conservation Bureau of the Ministry of the Environment in Japan), bathing in a radioactive springs may alleviate the effects of gout, arteriosclerosis, and hypertension as well as chronic conditions such as cholecystitis, gallstones, and skin and gynecological diseases. Drinking water from these springs may treat gout, chronic digestive disorders, chronic cholecystitis, gallstones, neuralgia, muscle pain, and arthralgia. To determine exposure doses from radioactive springs, it is important to establish an easy and accurate method of measuring radon concentration in water and humid air in bathing areas. Methods: This study measured the concentration of airborne radon using an activated charcoal detector (PICO-RAD: AccuStar Labs), desiccant (Drierite; 8 mesh of anhydrous calcium sulfate: W.A. Hammond Drierite Company, Ltd.), a liquid scintillation counter (LSC LB-5: Hitachi Aloka Medical, Ltd.), and 2,5-diphenyloxazole(DPO) + 1,4-bis (5-phenyl-2-oxazolyl) benzene(POPOP) toluene solution (Wako Pure Chemical Industries, Ltd.) were used as the liquid scintillator. Results and Conclusions: This study evaluated radon exposure doses due to radioactive spring at a spa in Komono town, Mie prefecture. After water was piped from hot spring storage tanks into bathtubs, only 5.3-18.0% of the radon remained in the water. Two days later, only 0.25% remained, likely due to radioactive decay and increased diffusion into the air from bathing and recirculating filters. Thus, we investigated radon levels in the humid bathroom air around the radioactive hot spring and determined the total radon exposure from spa water and air. The total exposure dose was calculated assuming a two-day stay, during which customers used the bath for some number of hours. Our findings confirm the safety and efficacy of the hot spring facility. This study was supported in part by a grant from the Daido Life Welfare Foundation.