A 56-year-old man, who was admitted with cerebral infarction in our hospital, was infected with MRSA, probably through the gastrointestinal endoscopy. Taking advantage of this episode, we reevaluated the procedure of cleaning and disinfection for endoscopes by bacteriological examination. Before encountering the MRSA case, we had routinely used a simple cleaning procedure. After an examination was over, an endoscope was wiped up with ethanol-soaked gauze, sucked an enzymatic detergent, water and positive soap solution through the biopsy-suction channel, and lastly was washed by the automated reprocessor (3-5 minutes for total process), if the patient was free of infectious diseases such as hepatitis B, C and syphilis. In this symple method, bacteria were detected in 10 out of 46 samples from after-cleaning endoscopes. The results were such that we adopted the new procedure for cleaning and disinfection as follows ; after wiping the surface of an endoscope by propanol-wet gauze, an endoscope was washed by neutral detergent manually, and the biopsy-suction channel was brushed up three times. Then, the endoscope was completely immersed in a 2% glutar aldehyde solution. In this procedure, no bacterium was detected in the samples from the endoscopes. However, as the concentration of glutar aldehyde rapidly decreased, it is necessary to use a test strip specific for the minimum effective concentration of glutar aldehyde frequently to monitor the potency of such solution

　The WHO reported the importance of IPE (Interprofessional Education) in order to implement team-based medicine smoothly. Some Japanese medical educational institutes presented their IPE programs, which involved real patients, but most IPE programs used scenario-based or standardized patients. Moreover, few reports showed IPE programs for diabetic patient education. We created a new program, called the "Diabetes education class IPE" . Participants were 2 medical, 4 nursing, 4 pharmacy, and 3 dietician students. The students experienced the planning and management of and reflection on diabetes education classes. As a result of reflection, the "Diabetes education class IPE" was viewed as a useful IPE program.

Purpose: Head and neck cancer patients receiving chemoradiation therapy often suffer from severe mucositis. Chemoradiation therapy-induced mucositis is usually accompanied by severe and intractable pain that impairs quality of life. To establish an effective method for treatment of mucositis pain, we retrospectively investigated the relationships of radiation dose with severity of mucositis and opioid consumption. We also conducted a survey on satisfaction of pain treatment. Methods: Study 1: Fourteen patients who underwent chemoradiation therapy of 70 Gy for head and neck cancer from 2005 to 2009 participated in the study. The relationship of severity of mucositis with opioid use was studied. Study 2: Seven patients who had mucositis of over grade 3 and had completed radiation therapy participated in the study. We carried out a questionnaire survey about satisfaction of each pain treatment. Results: Study 1: Increase of radiation dose significantly worsened the severity of mucositis. Opioid consumption for treating pain was significantly greater in the pharynx cancer group than in the oral cancer group. Study 2: Oral care treatment was preferred to systemic administration of analgesics including opioids. Conclusions: In the oral cancer group, oral care treatment was thought to be useful for pain treatment. Oral cancer patients needed less opioids than did pharynx cancer patients.

We performed combination therapy with modified oxaliplatin/l-LV/5-FU (mFOLFOX) in a patient with recurrent colorectal cancer who had peritonitis carcinomatosis. In this patient, mFOLFOX therapy resulted in disappearance of ascites and a decrease in carbohydrate antigen 19-9 (CA19-9), and improved quality of life (QOL) of the patient. This 62-year-old man was diagnosed with ascending colon cancer and metastatic cancer of the liver. Right hemicolectomy and right hepatic lobectomy were performed. We had started to treat with TS-1 in ambulatory care, however, he had peritonitis carcinomatosis with massive ascite reservoir on CT and peritoneal dissemination after a half year postoperatively. Furthermore, his ECOG Performance Status (PS) was rated as level 3. Therefore, we performed puncture of ascites and palliative mFOLFOX6 therapy. After ten courses, ascites and abdominal induration had disappeared and PS recovered to level 1. At present, CPT-11/l-LV/5-FU (FOLFIRI) are being administered for peripheral neuropathy and metastatic tumor associated with mFOLFOX6. The patient is spending his daily life satisfactory after FOLFIRI without abdominal swelling or ascites, and thus mFOLFOX6 may be an option for palliative therapy against massive ascites in patients with advanced colorectal cancer. The usefulness of palliative mFOLFOX6 therapy for patients with massive ascites should be evaluated in a well-designed clinical trial.Palliat Care Res 2008; 3(2): 316-320

OBJECTIVES: In recent years, transboundary air pollution from mainland East Asia has led to growing concerns about air pollution in Japan. Air pollution is reportedly associated with the exacerbation of respiratory diseases. In this study, we assessed the effects of air pollution on respiratory symptoms and the health status of participants with and without chronic respiratory diseases. METHODS: Participants (n=2753) with and without chronic respiratory diseases who visited healthcare facilities in Japan during February from 2010 to 2015 filled out a self-report questionnaire regarding their symptoms and perceived health status. Participants were followed up during April-May and June-July. RESULTS: Oxidant concentrations were associated with respiratory symptoms, overall health, and quality of life (QoL). Suspended particulate matter (SPM) and particulate matter <2.5 μm levels were associated with physical fitness; SPM was also associated with QoL. Recent experience of an Asian sand dust event had a significant effect on allergic symptoms, change in health, and QoL. CONCLUSIONS Respiratory symptoms were more strongly affected by oxidants than by other pollutants. Significant associations of air pollutants were found with a comprehensive range of items related to perceived health status, including overall health and QoL. Although the effects of air pollutants on respiratory symptoms and health status were more apparent among patients with respiratory diseases, the adverse effects of air pollutants were significant even among participants without such conditions.

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.