Clinical decisions on infectious diseases in terminally-ill cancer patients are often made based on physicians’ and nurses’ personal medical experiences, which may lead to an intra-team conflict. We conducted a qualitative analysis with prospectively gathered, semi-structured interviews in order to identify physicians’ and nurses’ beliefs and perceptions contributing to the variabilities in their attitudes toward patient care and the conflicts during decision-making process. We obtained the following categories with respect to beliefs and perceptions: estimated prognosis; patient’s discomfort due to tests and treatment; agreement to physician’s treatment plan; patient’s and family’s wish for tests and treatment; and patient’s benefits by tests and treatment. The intra-team conflicts resulted from disagreement on patient’s condition, and difficulty understanding mutual intent or opinion among physicians and nurses. Our findings may help improve team-based communication and the quality of care in terminally-ill cancer patients with infectious diseases.

This study aimed to explore participant experiences and perspectives of a multidisciplinary conference held after a cancer patient's death in the home setting under planning by the regional palliative care team. The multidisciplinary conferences studied were held in the community following the deaths of three cancer patients who were cared for at home or in nursing homes and supported by a regional palliative care team. We surveyed a total of 56 participants across the three conferences using a questionnaire comprising demographical questions and free description. We asked for impressions of the conference and perspectives regarding palliative care. The survey drew 48 effective responses (response rate, 87.5%). Content analysis of the participants' descriptions extracted the following issues with the multidisciplinary conferences, categorized under either as availability or problems: “mutual understanding through dialogue between multidisciplinary members”, “awareness leading to future practice”, “learning about palliative care”, and “barrier to dialogue between multidisciplinary members”. Highlighted problems surrounding the practice of palliative care with multi-institutional and multidisciplinary members were “conditions for practice in palliative care and care for dying patients” and “multi-institutional and multidisciplinary coordination”. The results indicated that multidisciplinary conferences held with the regional palliative care specialists following a cancer patient's death might be useful to facilitate multidisciplinary coordination and lead to better practice in palliative care in the community.

We report a patient with unilateral midbrain hemorrhage which caused ipsilateral complete oculomotor nerve palsy with pupillary involvement, contralateral upgaze paresis, contralateral limb ataxia and Parinaud’s syndrome. CT scan and MRI brain demonstrated a hemorrhage in the left paramedian midbrain probably involving the oculomotor fascicles; extension of the hemorrhage to the most rostral midbrain may have involved the pupillary fi bers. It was previously thought that a lesion in the superior colliculus, surrounding nuclei (Darkschewitsch and Cajal nuclei), and the posterior commissure (i.e. dorsal midbrain) were responsible for clinical fi ndings similar to those found in our patient, but our patient showed a hemorrhagic lesion in the left ventral midbrain which did not extend to dorsal midbrain. We propose that the responsible lesion in our patient might involve the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF).

Background: Follicular tumors include follicular thyroid adenomas and carcinomas; however, it is difficult to distinguish between the two when the cytology or biopsy material is obtained from a portion of the tumor. The presence or absence of invasion in the resected material is used to differentiate between adenomas and carcinomas, which often results in the unnecessary removal of the adenomas. If nodules that may be follicular thyroid carcinomas are identified preoperatively, active surveillance of other nodules as adenomas is possible, which reduces the risk of surgical complications and the expenses incurred during medical treatment. Therefore, we aimed to identify biomarkers in the invasive subpopulation of follicular tumor cells. Methods: We performed a spatial transcriptome analysis of a case of follicular thyroid carcinoma and examined the dynamics of CD74 expression in 36 cases. Results: We identified a subpopulation in a region close to the invasive area, and this subpopulation expressed high levels of CD74. Immunohistochemically, CD74 was highly expressed in the invasive and peripheral areas of the tumor. Conclusions Although high CD74 expression has been reported in papillary and anaplastic thyroid carcinomas, it has not been analyzed in follicular thyroid carcinomas. Furthermore, the heterogeneity of CD74 expression in thyroid tumors has not yet been reported. The CD74-positive subpopulation identified in this study may be useful in predicting invasion of follicular thyroid carcinomas.

OBJECTIVE: The aim of this study was to explore the factor structure of a novel, 10-item rating scale, the Targeted Inventory on Problems in Schizophrenia (TIP-Sz). Determining the factor structure will be useful in the brief evaluation of medication and non-medication treatment of the disease. METHODS: An exploratory factor analysis was performed on TIP-Sz scores obtained from 100 patients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for schizophrenia. RESULTS: The factor analysis extracted four factors that were deemed clinically pertinent, which we labeled: disorganization, social cooperativeness, functional capacity, and emotional state. The items exhibited cross-loadings on the first three factors (i.e., some items loaded on more than one factor). In particular, the 'behavioral dyscontrol and disorganization,' 'insight and reality testing,' and 'overall prognostic impression' items had comparable cross-loadings on all of the first three factors. The emotional state factor was distinct from the other factors in that the items loading on it did not cross-load on other factors. CONCLUSION: The TIP-Sz scale comprises factors that are associated with the psychosocial functioning and emotional state of patients, which are important outcome parameters for successful treatment of the disease.
Anomie ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Schizophrenia

We evaluated the role of pharmacists in an interdisciplinary pain center using text mining analysis. We investigated 28 patients who visited an interdisciplinary pain center from May 2014 to July 2015. All patients were interviewed by a pharmacist. Further, we performed morphological analysis of medical records; classification of appearing words into “medicines/side effects,” “diagnosis/disease name,” “pain site,” “pain characteristics/concomitant symptoms,” “life/environment,” and “mental”; and correspondence analysis. The frequently appearing words “pain characteristics/concomitant symptoms” and “medicines/side effects” were used by 47.2% doctors and 35.3% pharmacists, respectively. In the correspondence analysis, doctors frequently referred to “pain characteristics/concomitant symptoms,” pharmacists frequently referred to “medicines/side effects,” and nurses frequently referred to “life/environment” and “pain site.” The fact that the three occupations used distinguishing phrases suggests that each is specialized in a distinct area. At an interdisciplinary pain center, we interviewed a nurse, a pharmacist, and a doctor, and shared information from various angles. The pharmacist focused on listening to the “medicines/side effects,” which is information related to his profession. Pharmacists contribute to medical care by recording information in medical records and sharing the information with other occupations. It is necessary to continue to provide information related to our specialized profession, respect each other, and provide high-quality medical care.

Distigmine has reversible and persistent cholinesterase (ChE) antagonism, and is used for the dysuria due to low activity bladders such as the neurogenic bladder dysfunction widely postoperatively, but fatal cases were reported by cholinergic syndrome. Therefore a dose was limited to 5mg only for adaptation of “the dysuria due to hypotonic bladder such as after surgery and the neurogenic bladder dysfunction” in March, 2010. In the current study, we examined a ministerial policy in the package insert revision using Japanese Adverse Drug Event Report database (JADER). Using a side effect report registered with JADER from January, 2004 to June, 2016, we calculated Reporting Odds Ratio (ROR) which was the index of the safe signal of the medical supplies adverse event and we compared number of reports and ROR of the cholinergic syndrome by the distigmine in approximately the measure in March, 2010 and evaluated it. The number of reports of the cholinergic syndrome by the distigmine was 138 cases before March 2010 and 65 cases after March 2010. After a measure, the number of reports decreased. The possibility that the package insert revision of the distigmine contributed to a decrease in cholinergic syndrome onset was suggested. Whereas monitoring careful sequentially needs the onset of the cholinergic syndrome in constant frequency to be found.