Two years have passed since a patient who started to use the respirator for a tuberculosis sequela and chronic respiratory failure at home. During this period, the patient got several short-term admissions into the hospital. After his first discharge, the patient and his family felt anxiety about recupration at home. It was the first time for us to provide home care services to a respirator wearing patient. However, the shift to recuperation at home was realized as an understanding was reached between physicians who decided upon care home and the patient's wife who wished “to live with the husband together”. The patient is now playing a role as a father and as a husband, and he is leading a full life. In this study, the personal and familial circumstances of the patient, decision-making about home care and community support were analized. We coucluded that there were several important factors for successful recuperation at home:specification of contents of concrete medical support to a patient and a family;an immediate suitable action at the time of change of a patient's condition;taking periodic rests of a patient and a family;and a good family relationship.
Patients ; Ventilators, Mechanical ; seconds ; Family ; Home

Objective: This study aimed to enhance Drug Information Practice Experiences (DIPE) in Japan by comparing DIPEs at Tohoku University Hospital (TUH) with Nova Southeastern University (NSU) in the United States, and propose an advanced model of drug information (DI) education in Japan.
Methods: We performed the following: (i) comparison of both DIPEs based on Model Core Curriculum (MCC) content; (ii) identification of practices which were not part of NSU or TUH DIPE; (iii) comparison of students’ DIPE performance based on MCC: (A) students’ performance without the preceptors and their post-performance approval, (A’) students’ performance without the preceptors and their pre-performance approval, and (B) students’ performance under direct preceptor supervision; (iv) highlighting differences between TUH and NSU DIPEs; and (v) proposing an advanced model of DI education in Japan.
Results: (i) The NSU DIPE is similar to the MCC.  An example difference between NSU and TUH learning strategies was that NSU students responded to the inquiries made by the phone whereas TUH students receive assignments and explanation from preceptors.  (ii) DIPE at NSU utilized oral presentations and student interaction in many forms (e.g. journal club, reflection regarding learned topics).  On the other hand, DIPE at TUH helped students learn about Medical Representative jobs and educated them in tablet/capsule identification practices.  (iii) In contrast, the TUH curriculum limits students’ performance to “experience via dissemination with health professional needs and patients’ needs”.  (iv) These clarified points are considered to be differences between DIPE at TUH and NSU.  (v) Following analysis of these points, an advanced model of DI education based on responses to DI phone inquiries and oral presentations including a journal club was proposed.
Conclusions: This study will contribute to improving DI education in Japan.

STUDY DESIGN: Retrospective, radiological study. PURPOSE: To determine the relationship between clinical symptoms and the extent of tumor occupation of the spinal canal by cauda equina schwannoma. OVERVIEW OF LITERATURE: Little is known about the relationship between the size of tumors of the cauda equina and the manifestation of clinical symptoms. We analyzed this relationship by estimating the percentage of tumor occupation (PTO) in the spinal canal in cauda equina schwannomas and by correlating this parameter with the presence and severity of clinical symptoms. METHODS: Twenty-two patients (9 men and 13 women; age, 19–79 years; mean age, 55.3 years) who were radiologically diagnosed with schwannomas of the cauda equina between April 2004 and July 2014 were retrospectively analyzed. PTO was measured in axial and sagittal magnetic resonance imaging slices in which the cross-sectional area of the tumor was the largest. Data regarding clinical symptoms and results of physical examinations were collected from patient medical records. PTO differences between symptom-positive and -negative groups were analyzed for each variable. RESULTS: In the 4 cases in which tumor presence was not related to clinical symptoms, PTO was 5%–10% (mean, 9%) in axial slices and 23%–31% (mean, 30%) in sagittal slices. In the 18 cases in which symptoms were associated with the tumor, PTO was 11%–86% (mean, 50%) in axial slices and 43%–88% (mean, 71%) in sagittal slices. PTO in axial slices was significantly higher in the presence of Déjèrine symptoms and/or muscle weakness, a positive straight leg raise test, and a positive Kemp sign. CONCLUSIONS: PTO >20% in axial slices and >40% in sagittal slices can be an indication of symptomatic cauda equina schwannoma.
Cauda Equina* ; Female ; Humans ; Leg ; Magnetic Resonance Imaging ; Male ; Medical Records ; Muscle Weakness ; Neurilemmoma* ; Occupations* ; Physical Examination ; Retrospective Studies ; Spinal Canal*

STUDY DESIGN: A retrospective study. PURPOSE: To examine the effectiveness of using an electrodiagnostic technique as a new approach in the clinical diagnosis of extraforaminal stenosis at L5-S1. OVERVIEW OF LITERATURE: We introduced a new effective approach to the diagnosis of extraforaminal stenosis at the lumbosacral junction using the existing electrophysiological evaluation technique. METHODS: A consecutive series of 124 patients with fifth lumbar radiculopathy were enrolled, comprising a group of 74 patients with spinal canal stenosis and a second group of 50 patients with extraforaminal stenosis at L5-S1. The technique involved inserting a pair of needle electrodes into the foraminal exit zone of the fifth lumbar spinal nerves, which were used to provide electrical stimulation. The compound muscle action potentials from each of the tibialis anterior muscles were recorded. RESULTS: The distal motor latency (DML) of the potentials ranged from 11.2 to 24.6 milliseconds in patients with extraforaminal stenosis. In contrast, the DML in patients with spinal canal stenosis ranged from 10.0 to 17.2 milliseconds. After comparing the DML of each of the 2 groups and at the same time comparing the differences in DML between the affected and unaffected side of each patient, we concluded there were statistically significant differences (p<0.01) between the 2 groups. Using receiver operating characteristic curve analysis, the cutoff values were calculated to be 15.2 milliseconds and 1.1 milliseconds, respectively. CONCLUSIONS: This approach using a means of DML measurement enables us to identify and localize lesions, which offers an advantage in diagnosing extraforaminal stenosis at L5-S1.
Action Potentials ; Constriction, Pathologic* ; Diagnosis* ; Diagnostic Techniques and Procedures ; Electric Stimulation ; Electrodes ; Humans ; Muscles ; Needles ; Radiculopathy ; Retrospective Studies ; ROC Curve ; Spinal Canal ; Spinal Nerves ; Spinal Stenosis

BACKGROUND: Atopic dermatitis (AD) in infants is often related to food allergies (FA). The beneficial effects of lactic acid bacteria towards allergic diseases have been reported, but there are few reports on their effect and preferable dosages on AD in young children with concomitant FA. OBJECTIVE: To examine additional effects of two different dose of paraprobiotic Lactobacillus acidophilus L-92 (L-92) on the clinical treatment in young children afflicted by AD with diagnosed or suspected FA. METHODS: Fifty-nine AD young children from 10 months to 3 years old, with FA or who had not started to ingest specific food(s) because of high specific IgE levels, were recruited and randomly allocated into L-92 group (daily intake of 20 mg L-92/day) and placebo group. Participants were given test sample with conventional treatment for AD over a 24-week period. The severity of eczema was evaluated using SCORing Atopic Dermatitis (SCORAD) index before intervention, and at 4, 12, and 24 weeks after intervention. RESULTS: After 24 weeks of intervention, a significant decrease in SCORAD was observed only in the L-92 group when compared with the baseline values. Significant decreases in thymus and activation-regulated chemokine (TARC) and total IgE were also detected 24 weeks after intake in the L-92 group compared with the placebo group. CONCLUSION: It was suggested that intake of sufficient amounts of L-92 works as an adjunctive treatment of young children afflicted by AD with diagnosed or suspected FA.
Bacteria ; Chemokine CCL17 ; Child ; Dermatitis, Atopic ; Eczema ; Food Hypersensitivity ; Humans ; Immunoglobulin E ; Infant ; Lactic Acid ; Lactobacillus acidophilus ; Lactobacillus

Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.

Purpose：The Southampton Hand Assessment Procedure (SHAP) is a test of upper extremity function composed of 12 movement tasks and 14 activities of daily living tasks, and is used as an assessment battery for upper extremity prostheses. The purpose of this study is to examine its validity in clinical practice.Methods：The study included 143 patients with hemiparesis. The validity of SHAP and an existing assessment battery were compared in this study. Factors influencing the validity of differences between dominant and non-dominant hands were examined.Results：Concomitant validity was shown between the SHAP Japanese version and an existing upper extremity function evaluation method. A strong correlation with the subjective evaluation scale was obtained in cases of dominant hand paralysis.Discussion：These results suggested that SHAP is able to accurately evaluate upper extremity hemiparesis, because the difficulty level in evaluation of upper extremity function is higher than that of the Action Research Arm Test, and a ceiling effect is unlikely. Therefore, SHAP is useful in clinical practice not only for assessment of an artificial hand but also for hemiparesis with stroke. Further study to clarify the characteristics of SHAP as well as verification of reliability and standard values is warranted.

Objective: Several evidence-based practice guidelines have been developed to better treat bipolar disorder. However, the articles cited in these guidelines were based on clinical or basic studies with specific conditional settings and were not sufficiently based on real-world clinical practice. In particular, there was little information on the doses of mood stabilizers. Methods: The MUlticenter treatment SUrvey on BIpolar disorder in Japanese psychiatric clinics (MUSUBI) is a study conducted to accumulate evidence on the real-world practical treatment of bipolar disorder. The questionnaire included patient characteristics such as comorbidities, mental status, treatment period, Global Assessment of Functioning (GAF) score, and details of pharmacological treatment. Results: Most patients received mood stabilizers such as lithium (n = 1,317), valproic acid (n = 808), carbamazepine (n = 136), and lamotrigine (n = 665). The dose of lithium was correlated with age, body weight, number of episodes, depression and GAF. The dose of valproic acid was correlated with body weight, number of episodes, presence of a rapid cycle and GAF. The dose of carbamazepine was correlated with age, mania, and the presence of a rapid cycle. The dose of lamotrigine was correlated with the number of episodes, depression, mania, psychotic features, and the presence of a rapid cycle. Doses of coadministered mood stabilizers were significantly correlated, except for the combination of valproic acid and lamotrigine. Conclusion The dose of mood stabilizers was selectively administered based on several factors, such as age, body composition, current mood status and functioning. Further prospective studies are required to confirm these findings.