In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.

In August 2001 we began to use WELPAS (a benzalkonium chloride solution) as part of our cost-containment drive, replacing self-made glycerol-added ethanol, which had been used for a long time to prevent nosocomial infections. Since then, blackish stains have become particularly noticeable here and there on the floorboards of the passageways in the hospital wards. The newly adopted quick-drying hand disinfectant was suspected as the culprit. To find the real cause of the dirt, we built a hallway similar to the real passageway for experiment. The disinfectant agents used were WELPAS, WELLUP (chlorhexidine gluconate), HIBISOFT (chlorhexidine gluconate), medicinal ethanol, cationic detergent solution, HIBITANE solution (chlorhexidine hydrochioride) and glycerol solution. These agents and distilled water were dropped on a limited area of the floor respectively for comparison of the degrees of dirt. The cationic detergent solution and WELPAS containing cationic detergent left blackish stains that were hardest to remove. From this finding, it was inferred that the cationic detergent solution was responsible for the dirt on the floor. So we decided to switch to a quick-drying hand disinfectant which does not contain cationic detergents. After considering economic benefit, we chose WELLUP which contains medicinal alcohol plus chlorhexidine gluconate and put it into actual use in October 2003. Since then, the hospitall floors have become unmistakalbly clean.
Solutions ; Disinfectants ; Hand ; Detergents ; Desiccation

  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.

Primary malignant cardiac tumors are extremely rare. Among these, leiomyosarcoma are particularly exceptional and only about 20 surgically treated cases have been extensively described. We describe a case of right atrial leiomyosarcoma which was accidentally found by computed tomography. The tumor was surgically resected under extracorporeal circulation. Two months later the patient had cerebral hemorrhage due to a brain metastasis, which almost completely disappeared after irradiation. There was no other evidence of recurrence for 12 months after operation.

  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.

At Nippon Medical School, a "Basic Clinical Training Course" is provided as an introduction to clinical medicine. Medical students undergo initial clinical skills training with simulators. We describe the technique of effective training to acquire clinical skills and the results of student evaluations and a questionnaire survey.1) The training consisted of 8 practicums, including internal examination, funduscopic examination, otoscopic examination, breast examination, auscultation (heart sounds and lung sounds), and collection of blood samples. Medical students moved in rotation once per time period (45 minutes) and performed practical training in each unit, which comprised 2 practicums.2) The training with the prescribed number of 50 students in 4 time periods was efficiently performed for 2 days and required 9 trainers per day. Student evaluations and a questionnaire survey revealed the interest and enthusiasm of medical students and showed they thought highly of the training.3) The training was efficiently performed and was thought to help reduce the teaching load of instructors. The educational effect of the training can be strengthened by increasing the convenience of the clinical simulation laboratory, by reinforcing the education of clinical skills and attitudes in clinical clerkship, and by evaluating these factors after the completion of the clinical clerkship.

BACKGROUND/AIMS: The present study aimed to evaluate the safety and efficacy of simeprevir-based triple therapy with reduced doses of pegylated interferon (PEG-IFN) and ribavirin for interferon (IFN) ineligible patients, such as elderly and/or cirrhotic patients, and to elucidate the factors contributing to a sustained virologic response (SVR). METHODS: One hundred IFN ineligible patients infected with genotype 1b hepatitis C virus (HCV) were treated. Simeprevir (100 mg) was given orally together with reduced doses of PEG-IFN-α 2a (90 μg), and ribavirin (200 mg less than the recommended dose). RESULTS: The patients’ median age was 70 years, and 70 patients were cirrhotic. Three patients (3%) discontinued treatment due to adverse events. The SVR rate was 64%. Factors that significantly contributed to the SVR included the γ-glutamyl transferase and α-fetoprotein levels, interleukin-28B (IL28B) polymorphism status, and the level and reduction of HCV RNA at weeks 2 and 4. The multivariate analysis showed that the IL28B polymorphism status was the only independent factor that predicted the SVR, with a positive predictive value of 77%. CONCLUSIONS: Simeprevir-based triple therapy with reduced doses of PEG-IFN and ribavirin was safe and effective for IFN ineligible patients infected with genotype 1b HCV. IL28B polymorphism status was a useful predictor of the SVR.
Aged ; Genotype* ; Hepacivirus* ; Hepatitis C* ; Hepatitis* ; Humans ; Interferons* ; Multivariate Analysis ; Ribavirin* ; RNA ; Simeprevir ; Transferases