Six (1.2%) of 501 patients sustained phrenic nerve injury during operation for congenital heart disease at our institutions between 1992 and 1998. The diagnosis was confirmed by percutaneous stimulation of the phrenic nerve. All but 1 patient were less than 9 months old, and the average weight was 3.6kg. All 6 patients underwent diaphragmatic plication and were extubated by 7 days after operation. Percutaneous stimulation of the phrenic nerve allowed direct assessment of phrenic nerve function which was difficult to detect by clinical and radiological evidence. This method can be non-invasively used at the bedside to facilitate early and accurate diagnosis of phrenic nerve palsy.

The usefulness of individual care of patients in the attitude education of undergraduates was evaluated with questionnaires completed by 4th-year medical students and patients. Ninety-eight percent of students finished performing patient care during a 2-week period. Seventy percent of patients completed questionnaires. The appearance, manner of greeting, and language of the students were considered good by 87% or more of the patients, and the students' consideration for the patients' safety, privacy, and communication was considered good by 86% or more of the patients. The practice was approved by 77% of the patients and was objected to by none. Ninety-nine percent of students completed questionnaires, and 79% of the respondents approved of the practice. Fourteen percent of the student respondents, many of whom had been treated as outpatients, objected to the practice. These results suggest that individual care of patients by medical students is useful for both patients and students.

Objective: Sodium valproate granules (VPA granules) are extremely hygroscopic, deliquesce slowly in the air, and aggregate depending on temperature and humidity conditions. Although pharmacists are required to maintain drug storage conditions until the time of dispensing, they cannot keep track of the actual storage conditions maintained by the patients thereafter. Therefore, we investigated the actual temperature and humidity of the storage conditions maintained by the patients after delivery of the VPA granules.Methods: We conducted a prospective observational study at Kameda Medical Center on pediatric outpatients who were prescribed VPA granules from July 5, 2018 to February 20, 2019. A portable data logger capable of measuring temperature and humidity for 24 h was delivered at the time of dispensation. At the following visit, the data logger was collected, and data about temperature and humidity were obtained. We defined the suitable temperature as 1.0-30.0℃ and suitable humidity as 75.0% or less.Results: In this study, 13 patients were included. In total, 18 data loggers were distributed, and the return rate was 100.0%. The storage temperature was outside the suitable range in 0.8% of the total observation time whereas the humidity exceeded 75.0% in 1.7% of the total observation time.Conclusion: Storage of medications after dispensation was evaluated, and certain temperature and humidity deviations were observed. As storing a drug in an inappropriate environment changes the nature of the drug, affecting its efficacy and safety, it is necessary to educate patients on the proper methods to store oral medications.