In the orthopedics ward in our hospital, as is the case with other hospitals, many patients with spine or hip-joint ailments are bedridden with their face up for days. A previous survey found that among what feel the most inconvenient is evacuation. For those having problems in passing stools, the use of mild laxatives, suppositories or enemas has been common.However, in search of some other means which are fundamental and more suitable for nursing care, we tried cold drinking water and abdomen massage. The result was very helpful. Cold water drinking and massaging made the stomach and the intestine active and prompted evacuation. With this finding, the nurses in our hospital have realized the importance of returning to the basics of nursing care before turning to the drugs. Now, these procedures have been established in our hospital.

We four medical students (one in the 2nd year and three in the 3rd year) visited Thomas Jefferson University in Philadelphia for 2 weeks during spring vacation. We audited classes to study differences in medical education and visited the hospital to observe common medical practices in the United States. Because of this experience, we started to rethink medical care in Japan as well as our future commitment to medicine.

We experienced a surgically treated case of chronic contained rupture of a common iliac artery aneurysm. A large number of cases of chronic contained ruptures of the abdominal aorta have been reported; however, that of the common iliac artery is very rare. A 66-year-old man was injured in a bicycle accident. Three months later, the patient felt a dull abdominal pain and noticed a tumor in the left lower abdomen. On presenting computed tomography (CT) scan revealed an aneurysm of the left common iliac artery. After further examinations, a contained rupture of the left common iliac artery aneurysm was diagnosed. At operation, the main aneurysm, 7.5×6.5cm in size, was seen in the left common iliac artery, extending to the right common iliac artery and the infrarenal abdominal aorta. A 5.0×3.0cm tear, was found oil the posterior wall of the left common iliac aneurysm, surrounded by a huge hematoma. The aneurysm was resected and the abdominal aorta and the common iliac arteries were replaced with a Bard Albumin-coated DeBakey vascular bifurcated graft (16×8mm). The postoperative course was uneventful.

Purpose: We report a case in which oral sodium valproate through a percutaneous endoscopic gastrostomy (PEG) tube for palliative decompression drainage in inoperable ileus achieved an effective drug concentration and ameliorated delirium and extrapyramidal side effects. Case Report: The patient was a male in his seventies who suffered from bladder cancer. He underwent PEG because of paralytic ileus with cancerous peritonitis. He had been receiving continuous intravenous infusion of haloperidol for the management of delirium, but needed to discontinue treatment with this agent due to tremor, an extrapyramidal side effect of haloperidol. Oral sodium valproate was therefore administered through the PEG tube for palliative decompression drainage. Plasma valproate concentrations showed effective levels, and his irritability was relieved. A good combination of sodium valproate and quetiapine fumarate allowed successful reduction of and eventual withdrawal from haloperidol, and tremor then improved. Conclusion: We often encounter difficulty with symptom control for patients who cannot use oral medications. When medication by other routes is difficult, this case suggests that sodium valproate through a PEG tube for palliative decompression drainage may be useful as a last resort for improving delirium.

Purpose   The purpose of this study was to determine the relaxing effects of a hospital rooftop forest on healthcare workers and to assess the influence of trait anxiety. Methods   Sixteen male workers (aged 37.1±10.6years, mean±SD) and 56 female workers (aged 43.5±11.2years) participated in this study. Females were divided into 32low-to medium-anxiety and high-anxiety groups according to their trait anxiety as per the State Trait Anxiety Inventory-Form JYZ (STAI-Form JYZ). The experimental site was a rooftop forest, which covered an area of 122 m2, on the fourth storey of a health service facility. An outdoor car park area of 170m2, near the same facility, was used as a control. All participants were assessed individually at 3 sites: pre-room, rooftop forest, and outdoor car park area. Participants sat still in a wheelchair and viewed the scenery for 5minutes in each experimental area. The subjective effect was analyzed using the state anxiety as per the STAI-Form JYZ and the Profile of Mood States (POMS). The data between the rooftop forest and the control was compared within each participant. The participants were also divided into sex- and age-matched groups: A and B. Group A moved to the rooftop forest from the pre-room and group B first moved to the control area to eliminate the order effect. Results and Discussion   After viewing the rooftop forest, the mean values of state anxiety as per the STAY-Form JYZ showed a significant (p<0.01) decrease to 34.6±8.1 (43.4±8.4for control) in males and to 36.3±10.2 (45.8±8.8) in females. In low- to medium-anxiety females, state anxiety significantly (p<0.01) decreased to a“very low”anxiety state (“low” for control), and in high-anxiety females, it significantly (p<0.01) decreased to a “low” anxiety state (“intermediate” for control). As per the T-score of POMS, in males, “Fatigue” significantly (p<0.01) decreased to 39.0±7.5 (41.1±7.0) and “Vigor” significantly (p<0.01) increased to 43.3±10.4 (37.9±8.1). In females, “Tension-Anxiety” significantly (p<0.01) decreased to 39.7±7.7 (43.7±8.8), “Depression-Dejection” significantly (p<0.01) decreased to 43.5±6.3 (45.4±7.6), “Fatigue” significantly (p<0.01) decreased to 40.7±7.3 (43.6±8.5), and “Vigor” significantly (p<0.01) increased to 46.2±10.8 (38.9±8.0). After viewing the rooftop forest, the “iceberg profile” observed in the visual pattern of low- to medium-anxiety females indicated positive feelings. The “negative wing” indicating negative feelings observed in high-anxiety females in the pre-room disappeared after viewing the rooftop forest. Conclusion   We demonstrated that a short exposure to a rooftop forest environment induces a significant subjective relaxation effect in healthcare workers and that this effect is influenced by individual trait anxiety.

We have conducted a nationwide survey on faculty development for simulation-based medical education in Japan. The response rate was 90%. Forty-seven (68%) schools have implemented faculty development programs for simulation-based education. The most commonly implemented contents were standardized patient development, task trainer, high fidelity manikin operation, and student evaluation, which were related to objective structured clinical examination objective clinical skill assessment. Only 15 percent of medical schools implemented topics on reflective practice, and scientific writing. A constraint on faculty time was the most commonly perceived barrier to simulation use (mentioned by 62 schools; 90%).

Objectives: Spiritual pain is not formally defined. The aim of this study was to clarify the beliefs about spiritual pain among Japanese palliative care physicians and liaison psychiatrists and to compare their beliefs. Methods: A nationwide questionnaire survey was conducted by mail August, 2019 on certified palliative care physicians and liaison psychiatrists. We asked 9 questions about spiritual pain (i.e. current status, definition, and the delivery of care) using a 5-Likert scale. Result: 387 palliative care physicians (response rate, 53%) and 374 psychiatrists (45%) responded. 72% (76% of the palliative care physicians/69% of the psychiatrists) reported that spiritual pain was distinct from depression, but 69% (66/71) reported that it was not defined adequately; and 59% (59/60) perceived the risks of using the words ambiguously. Only 43% (40/47) recommended the universal definition of spiritual pain, and opinions about how spiritual pain should be defined (i.e, higher being, meaning/value, or specific terms) differed among physicians. Perception about spiritual pain of the physicians were significantly associated with their religion, while beliefs about spiritual pain were essentially similar between palliative care physicians and psychiatrists. Conclusion: Although physicians regarded the definition of spiritual pain as being inadequate, the opinions about preferable definition differed among physicians. Discussion about the value of developing a consensus of spiritual pain is needed.