In this study, we report a new network system to facilitate functional cooperation between medical and long-term care providers in the progressively aging society of Japan.Currently, medical and long-term care resources are not sufficient to meet the needs of the entire population and this presents a very serious problem. Sado City, on Sado Island in Niigata Prefecture, has a remarkable aging society, with elders accounting for 36.8% of the population. This is because both the patients and medical staff are aging. To conserve the limited medical resources of the island, a new system for inter-regional medical cooperation was initiated in April 2013. In this network system, the patient’s diagnosis, prescription, treatment, examination, and imaging results can be shared with all medical institutions that are part of the system. Every participating medical institution can either opt to introduce the electronic medical records system or use an alternative recording system, because the data for this inter-regional medical cooperation is extracted from medical treatment fees data. Nursing facilities can also access the data. Nursing care staff have information on their patient’s activities of daily living, routine vital signs, and other important data. In December 2013, a new initiative was started where nursing staff can not only receive their patients’ data, but also send data such as those mentioned above. To achieve functional cooperation between medical and long-term care providers, it is important to have access to all data and to communicate openly. The established system easily and effectively facilitates communication among staff and participating institutions.

Purpose: The long-term efficacy and safety of infliximab (IFX) in children with ulcerative colitis (UC) have not been well-evaluated. Here, we reviewed the long-term durability and safety of IFX in our single center pediatric cohort with UC. Methods: This retrospective study included 20 children with UC who were administered IFX. Results: For induction, 5 mg/kg IFX was administered at weeks 0, 2, and 6, followed by every 8 weeks for maintenance. The dose and interval of IFX were adjusted depending on clinical decisions. Corticosteroid (CS)-free remission without dose escalation (DE) occurred in 30% and 25% of patients at weeks 30 and 54, respectively. Patients who achieved CS-free remission without DE at week 30 sustained long-term IFX treatment without colectomy. However, one-third of the patients discontinued IFX treatment because of a primary nonresponse, and one-third experienced secondary loss of response (sLOR). IFX durability was higher in patients administered IFX plus azathioprine for >6 months. Four of five patients with very early onset UC had a primary nonresponse. Infusion reactions (IRs) occurred in 10 patients, resulting in discontinuation of IFX in four of these patients. No severe opportunistic infections occurred, except in one patient who developed acute focal bacterial nephritis. Three patients developed psoriasis-like lesions. Conclusion IFX is relatively safe and effective for children with UC. Clinical remission at week 30 was associated with long-term durability of colectomy-free IFX treatment. However, approximately two-thirds of the patients were unable to continue IFX therapy because of primary nonresponse, sLOR, IRs, and other side effects.

Purpose: The long-term efficacy and safety of infliximab (IFX) in children with ulcerative colitis (UC) have not been well-evaluated. Here, we reviewed the long-term durability and safety of IFX in our single center pediatric cohort with UC. Methods: This retrospective study included 20 children with UC who were administered IFX. Results: For induction, 5 mg/kg IFX was administered at weeks 0, 2, and 6, followed by every 8 weeks for maintenance. The dose and interval of IFX were adjusted depending on clinical decisions. Corticosteroid (CS)-free remission without dose escalation (DE) occurred in 30% and 25% of patients at weeks 30 and 54, respectively. Patients who achieved CS-free remission without DE at week 30 sustained long-term IFX treatment without colectomy. However, one-third of the patients discontinued IFX treatment because of a primary nonresponse, and one-third experienced secondary loss of response (sLOR). IFX durability was higher in patients administered IFX plus azathioprine for >6 months. Four of five patients with very early onset UC had a primary nonresponse. Infusion reactions (IRs) occurred in 10 patients, resulting in discontinuation of IFX in four of these patients. No severe opportunistic infections occurred, except in one patient who developed acute focal bacterial nephritis. Three patients developed psoriasis-like lesions. Conclusion IFX is relatively safe and effective for children with UC. Clinical remission at week 30 was associated with long-term durability of colectomy-free IFX treatment. However, approximately two-thirds of the patients were unable to continue IFX therapy because of primary nonresponse, sLOR, IRs, and other side effects.

In accordance with the new model-core-curriculum for medical education, the current status of education about the science of radiation health was surveyed in all medical schools in Japan. Among the four learning points related to the “Biological effects of radiation and radiation hazards” , about half of the schools covered issues on “radiation and human body” and the “effect of medical radiation exposure” in one, or less than one, 60-minutes class, but did not touch on “radiation risk communication” and “radiological disaster medicine” . A significant deviation of human resources was also observed between schools. Learning tools such as presentation files and video content were preferred as education support materials. Therefore, development and distribution of the learning tools, especially in “radiation risk communication” and “radiological disaster medicine” , may be a first step to promoting high-quality education on the science of radiation health risk in each school’s curriculum.