Vascular trauma of the upper extremities is rare. We have successfully treated a case of laceration of the right subclavian artery induced by chest injury. A 45-year-old man with blunt trauma was admitted and angiography revealed laceration of the right subclavian artery. The injured area was exposed by a median sternal approach. The right common carotid-subclavian artery bypass was successfully performed with autogenous vein graft in less than three hours from admission. He recovered without any neurological deficit or functional disability and returned to his former occupation.

This study aimed to clarify the resources required to relieve distress during palliative care delivery to cancer patients. Between April 2015 and March 2017, 1479 outpatients receiving chemotherapy for cancer were screened using the Japanese version of the Support Team Assessment Schedule (STAS-J). When the STAS-J result was 2 points and higher, the patient was considered positive for distress. A certified nurse or pharmacist performed STAS-J screening and, in cases where the patient exhibited distress, took steps to alleviate the problem themselves or consulted another resource. Distress was identified in 181 (12.2%) of the 1479 patients. These 181 patients needed 288 resources. The resources used to alleviate distress were categorized as follows: direct support by certified nurse or pharmacist (153), consultation with the attending physician (98) and other (37). The required resource included the following twelve professionals: attending physician, ophthalmologist, dermatologist, dentist, orthopedic surgeon, palliative care physician, certified nurse, certified pharmacist, medical social worker, clinical psychologist, volunteers for cancer patients, and palliative care team. The frequency of the intervention by the certified nurse or pharmacist (61, 39.9%) in directly alleviating psychiatric distress was significantly higher than by consultation with the attending physician (10, 10.2%) (p<0.0001). However, the frequency of consultation with the attending physician in alleviating physical distress (88, 89.8%) was significantly higher than that of the certified nurse or pharmacist (92, 60.1%) (p<0.0001). We conclude that the certified nurse or pharmacist is important for the delivery of palliative cancer care, because they can directly provide relief from psychiatric distress.

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.