Patients with dysphagia suffer from various degrees of difficulty in eating or swallowing. To improve their oral intake, meals must be provided with due consideration given to individual patient's eating ability. In this study, we examined a newly developed grading system of oral nutrition, which comprised 5 grades (I-V) based on the degree of difficulty in swallowing each formula. Grades I-III are meals suitable for swallowing training, grade IV represents meals that were enough to meet nutritional requirements, and grade V meals for the preparatory stage leading up to the changeover from liquid to solid foods.
  To assess the 5-step grading system of oral nutrition, we worked out average ingestion rates in 23 patients with dysphagia. The ingestion rate was 75±21% for patients on grade IV oral nutrition, and 74±19% for those on grade V, with a combined rate of 74±20%. This was higher than the average ingestion rate in a previous study conducted before our introduction of the grading system for oral nutrition (Journal of the Japanese Association of Rural Medicine 57: 83-88, 2008). We considered the surveillance data showed tendency to support the 5-step grading system, and in a case with dysphagia, this system actually brought about a remarkable improvement in ingestion. It has been introduced in our hospital since July 2008.

  Dietary management during chemotherapy for cancer can improve a patient's nutritional status through an adequate dietary intake, and increase the therapeutic effect.  In this study, we performed a questionnaire survey of inpatients in chemotherapy about their dietary preferences and changes in their senses of taste and smell, with the aim of producing a ‘chemotherapy menu’, utilizing recipes and foodstuffs to produce a palatable menu for those patients with their appetite diminished. We received responses from 102 out of 109 in patients surveyed (94%). Of the respondents, 66% rerealed that they had a decrease in appetite during chemotherapy, of whom 85% complained of extremely poor appetite. The smell of fish dishes disturbed 29% of the respondents, of whom 62% reported a stronger aversion to hot dishes. The foods easy to eat were found to be fruits, noodles, and soups. Meat and fish dishes, white rice, and stews were difficult to eat. Seasoning with tomato sauce made food difficult to eat for 44% of the respondents, whereas soy sauce was shunned by only 6%. The survey also found that 38% liked the use of Furikake (dried seasoning sprinkles), because it could make the meals palatable.  Based on the survey results, we devised an 8-day ‘chemotherapy menu’. It includes a Japanese style breakfast, with bread as an option, and many foods easy to eat, such as flavoured rice, sushi, noodles, sandwiches, and fruits. We have offered this menu to 47 inpatients, with average eating rates of greater than 70% for both rice and dishes. We will further conduct surveys with a view to producing a ‘chemotherapy menu’ palatable for as many patients as possible.

Objective: “Drug Guide for Patients” (DGP) is a drug information tool designated as one of the routine risk minimization activities in risk management plan (RMP) developed by the Ministry of Health, Labour and Welfare. However, patients and their families hardly recognize DGP. Therefore, we administered a questionnaire on drug consultation service of pharmaceutical companies that provide DGP with an aim to collect their views, elucidate problems when they prepare DGPs and examine effective utilization of DGP in the future.Methods: We sent a questionnaire by letter for 127 drug consultation service of pharmaceutical companies, and received questionnaire results using “Questant” that is web questionnaire making software. The results were examined using Fisher’s exact test or Pearson’s chi-squared test.Results: We obtained responses from 84 (66.1%) companies out of 127. As for the question of the published situation of DGP on their website, the most companies responded “Not published” with 47.6% and subsequently 41.7% for “Published for healthcare professionals”. The combined rate of “Published for Patients (3.6%)” and “Published for both healthcare professionals and patients (7.1%)” was only 10.7%. On the other hand, regarding the burden of companies making DGP, we found that more than 60% of pharmaceutical companies (63.5%) felt burdensome, whereas only 36.5% responded “Not burdensome.” Regarding the question on the role of DGP in RMP, pharmaceutical companies answered that the role is “sufficient” 3.6%, 29.8% “not sufficient”, and 66.6% “unknown”.Conclusion: Our results suggested that it is difficult for patients to get DGP from website of pharmaceutical companies and pharmaceutical companies felt burdensome in making DGP, and they recognized that DGP was not very much utilized by patients. Therefore, it would be necessary to improve the creation criteria of DGP. Furthermore, we felt it necessary to have the DGP known and utilized widely by (consumers and) patients.

Background/Aims: Recent studies indicate that probiotics, which have attracted attention as a treatment for irritable bowel syndrome, affect intestinal homeostasis. In this study, we investigated whether Zygosaccharomyces sapae (strain I-6), a probiotic yeast isolated from miso (a traditional Japanese fermented food), could improve irritable bowel syndrome symptoms. Methods: Male Wistar rats were exposed to water avoidance stress (WAS). The number of defecations during WAS and the visceral hypersensitivity before and after WAS were evaluated using colorectal distension. Tight junction changes were assessed by Western blotting. Some rats were fed with strain I-6 or β-glucan from strain I-6. Changes in the intestinal microbiota were analyzed.The effect of fecal microbiota transplantation after WAS was evaluated similarly. Caco-2 cells were stimulated with interleukin-1β and tight junction changes were investigated after coculture with strain I-6. Results: The increased number of stool pellets and visceral hypersensitivity induced by WAS were suppressed by administering strain I-6. The decrease in tight junction protein occludin by WAS was reversed by the administration of strain I-6. β-Glucan from strain I-6 also suppressed those changes induced by WAS. In the rat intestinal microbiota, treatment with strain I-6 altered the β-diversity and induced changes in bacterial occupancy. Upon fecal microbiota transplantation, some symptoms caused by WAS were ameliorated. Conclusions These results suggest that traditional fermented foods such as miso in Japan are valuable sources of probiotic yeast candidates, which may be useful for preventing and treating stress-induced visceral hypersensitivity.