We describe a case of meningeal carcinomatosis of the internal auditory meatus presenting as sudden deafness accompanied by dizziness. A 54-year-old woman complained of acute right-side hearing loss in October 2014. The pure tone audiometry test revealed right-side hearing loss of 47.5 dB. She was treated with oral steroids. Her hearing as well as her symptoms of dizziness worsened and she was admitted for further examination. Her right and left-side hearing had worsened to 105.0 dB and 47.5 dB, respectively. A magnetic resonance imaging scan of the head revealed bilateral enhancement of the internal auditory canal and multiple brain metastases. The chest radiograph revealed a mass in the left lung. Adenocarcinoma of the lung was diagnosed. Lumbar puncture yielded no evidence of carcinoma cells in the cerebrospinal fluid, but an increased number of lymphocytes was confirmed. A diagnosis of multiple brain metastases and leptomeningeal metastasis from the adenocarcinoma of the lung was considered. Whole-brain radiation therapy (30 Gr/10 fractions) was administered. Progressive bilateral hearing loss is a rare first manifestation of meningeal carcinomatosis. It is quite important to consider the possibility of this condition when patients present with sudden deafness.
Adenocarcinoma ; Audiometry ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Dizziness ; Ear, Inner ; Female ; Head ; Hearing ; Hearing Loss ; Hearing Loss, Bilateral ; Hearing Loss, Sudden ; Humans ; Lung ; Lymphocytes ; Magnetic Resonance Imaging ; Meningeal Carcinomatosis ; Middle Aged ; Neoplasm Metastasis ; Radiography, Thoracic ; Spinal Puncture ; Steroids ; Temporal Bone

Objective : Carvedilol is a non-selective β blocker with an α blocking activity. Since this drug is highly fat-soluble, it can pass through the blood-brain barrier, and thus may induce depression and lower QOL. In the present study, physicians and pharmacists collaborated to evaluate the antihypertension effect of carvedilol and post-administration changes in QOL. Furthermore, the relationship between QOL and antihypertension effect was analyzed.
Design : Self-controlled study.
Patients and Methods : Subjects were outpatients with hypertension above the age of 70 years who visited one of 42 medical institutions in Japan between April 1995 and March 1996. A total of 243 patients were registered, and 10-20 mg of carvedilol was administered once a day for six months. Pharmacists assessed the QOL of these patients by asking 82 questions on three separate occasions : before administration and one and six months after administration. The antihypertensive effect of this drug was investigated in patients in whom all three QOL questionnaires were collected. The main test items were antihypertensive effect, changes in QOL (subjective QOL with a special emphasis on patient psychology), and the relationship between antihypertensive effect and QOL. The antihypertensive effect of this drug was statistically analyzed by a paired t-test, and changes in QOL were statistically analyzed using generalized estimating equations.
Results : All three QOL questionnaires were collected from a total of 146 patients. Their pre-administration systolic blood pressure was 159.6±1.4 mmHg, and diastolic blood pressure 94.0±0.9 mmHg, and their blood pressure decreased significantly one month after the start of administration. This antihypertensive effect of carvedilol persisted, and the systolic and diastolic blood pressure of these patients six months after the start of administration was 141.1±1.2 and 85.2±0.7 mmHg, respectively (significant decreases when compared to pre-administration levels ; both p<0.05).
Subjective QOL improved significantly after carvedilol administration. And, changes were not seen in sexual function. Changes in the five categories of subjective QOL were as follows : psychological stability, disease-induced inconvenience, and independence improved significantly after carvedilol administration, but changes were not seen in gratification or vitality. However, improvements in subjective QOL did not correlate with improvements in blood pressure.
Conclusions : The results of the present study showed that carvedilol improved QOL without negatively affecting sexual function. Subjective QOL reflects the psychological well-being of patients. In the present study, psychological stability, disease-induced inconvenience, and independence improved significantly, but changes were not seen in gratification or vitality. Since β blockers can suppress the central nervous system, they can reduce psychological stability, gratification and vitality. Even though carvedilol is highly fat-soluble, the results of non-clinical studies have shown that it does not suppress the central nervous system as much as propranolol. The results of the present study showed that carvedilol does not strongly suppress the central nervous system of humans. Moreover, significant changes in QOL were not seen between one and six months after the start of administration of carvedilol, suggesting that it is possible to estimate the QOL of patients on antihypertensive therapy after six months of administration by assessing their QOL one month after administration.

Objective: This study aimed to determine if the discrepancy between depression severity rated by clinicians and that reported by patients depends on key behavioral/psychological features in patients with mood disorders. Methods: Participants included 100 patients with mood disorders. First, we examined correlations and regressions between scores on the Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI). Second, we divided the participants into those who provided 1) greater ratings for the BDI compared with the HAMD (BDI relative-overrating, BO) group, 2) comparable ratings for the BDI and HAMD (BDI relatively concordant, BC) group, or 3) less ratings for the BDI (BDI relative-underrating, BU) group. Adverse childhood experiences, autistic-like traits, and coping styles were evaluated with a six-item short version of the Childhood Trauma Questionnaire (CTQ-6), the Social Responsiveness Scale for Adults (SRS-A), and the Ways of Coping Checklist (WCCL), respectively. Results: A significant correlation was found between HAMD and BDI scores. Total and emotional abuse subscale scores from the CTQ-6, and the self-blame subscale scores from the WCCL were significantly higher for the BO group compared with the BU group. The BO group also elicited significantly higher SRS-A total scores than did the other groups. Conclusion These findings suggest that patients with adverse emotional experiences, autistic-like traits, and self-blame coping styles perceive greater distress than that evaluated objectively by clinicians. The results indicate the need for inclusion of subjective assessments to effectively evaluate depressive symptoms in patients deemed to have these psycho-behavioral concerns.

Introduction  Asahikawa Medical University has been conducting a JICA Knowledge Co-Creation Program (KCCP) “Health Administration for Community Health Officers in Africa” in Japan since 2008. Due to the COVID-19 pandemic, the KCCP in 2020 was a hybrid of distance learning and following on-site training in Japan, which the latter was canceled thereafter. This paper reports on how this hybrid program was organized and implemented.Methods: Preparation  The program was held in January-February 2021, with eight official participants from five countries and nine observers from two countries. The participants were required to engage in self-learning by PowerPoint materials with lecturers’ audio descriptions and zoom-based interactive meetings. The PowerPoint materials were freely accessible at our Google Drive account. There were 10 zoom sessions during the program.Results: Implementation  At the beginning, all the lecture materials were converted to mp4 clips and uploaded to a Youtube channel due to the difficulties downloading heavy files with limited internet connection. A total of 24 videos were created with an average length of 58 minutes in each. Zoom-based interactive meetings were held regularly in the morning in the African continent. Almost all of the sessions were productive, but the participants were sometimes interrupted due to a weak network environment or their regular work assignments. Most provided contents were well understood.Discussion  Despite some technical and environmental difficulties, the new-style, web-based training course facilitated the participation of observers as well as regular participants, providing more opportunities for interaction and discussion among trainees than a previous old-fashioned, on-site program. Improvement of the training environment particularly for participants is necessary to produce better training outcomes in the future, such as renting a hotel room and securing virtual connections.

Objective: This study evaluated the effectiveness of an end-of-life care simulation as a way to improve nursing students’ resilience. Methods: In total, 61 baccalaureate nursing students were randomly assigned to control or education groups. In this randomized controlled study on an end-of-life care simulation, resilience was measured at baseline, and after the simulation. Result: At the baseline, the two groups showed no statistical differences in their resilience scores. However, the total score, and scores for the factors “I am”, “I have”, and “I will/ do” were significantly higher for the education group than the control group in the post-test. The total scores and three factor scores within the education group were also significantly higher in the post-test than at baseline, but in the control group only the “I am” factor significantly increased over time. Conclusion: The end-of-life care simulation scenario showed the potential to increase the resilience of participants, especially their ability to build trusting relationships with others and expand their network, and to set goals and grow toward them.

Purpose: This study aimed to implement an end-of-life care simulation that was assessed at one facility (University A) on nursing university students in a different educational environment (University B), and assess the simulation through a review. Method: After the simulation, participants were asked to freely comment on the review sheet and the contents were analyzed. There were 12 participants. Results: Comments on the review sheet were summarized in 13 categories: self-understanding of nursing, realization of one’s positive view regarding nursing, acquisition of knowledge regarding communication, acquisition of knowledge regarding end-of-life, gaining learning opportunities, realization of effects from debriefing, positive change one experiences regarding nursing, acquisition of knowledge regarding nursing, realization of reality, assessment of teachers’ involvement, assessment of implementation method, assessment of the atmosphere of the venue, and assessment of experiences. Conclusion: Participants of the simulation can be expected to gain a similar learning experience regardless of the learning environment.

Purpose: To clarify the contents of nursing students’ feedback after they participated in a terminal care simulation. Method: Free description type answer sentences were analyzed qualitatively using Berelson’s content analysis. Results: Participants were 39 students. Feedback contents were divided into 334 recording units. As the result of analysis, 13 categories, including “acquisition of knowledge on communication,” “evaluation on method of implementation,” “self-understanding on nursing,” “self-positive-prospect on nursing,” “acquisition of knowledge on terminal care,” “evaluation on simulation ambience,” “acquisition of learning opportunities,” “self-positive-changing on nursing,” “effect of debriefing,” “effect of experience,” “feeling of reality,” “acquisition of knowledge on nursing” and “evaluation on faculty’s intervention” were formed. Conclusion: It was suggested that simulated patients contributed to making end of life clinical settings because the realism of the simulation had been apparent from the results. To make the terminal care simulation more developed, future studies should investigate how to give a briefing, and so on.

We established the Technical Aids Support Office in our hospital to promote the introduction of and technical advice about assistive technology so as to enhance the quality of care and the functioning of patients and ensure staff safety. In this paper, we introduce two complicated cases that needed individual support. Case 1: A patient with amyotrophic lateral sclerosis. The amount of assistance required had gradually increased, but the patient still hoped to use a portable toilet. Because he could barely stand up, the height of the toilet needed adjustment. An elevated seat decreased the amount of assistance required. However, raising the bottom of the portable toilet turned out to be a challenge. Case 2: Multiple limb amputee. The patient and the caregiver experienced pain and distress during transfer between bed and chair. We tried using a lift assist device, but it the hardness of the sling worsened pain at the stump. A cushion with a sliding seat was then placed between the sling and the patient to reduce friction. The shape and hardness of cushion is a future challenge to solve. Timely individual support at each stage in their care for individual patients is indispensable for the provision of technical aid support.