We have conducted driving fitness evaluations for post-illness patients in our clinic since 2008. Many patients expressed a desire to resume driving; thus, primary care physicians and rehabilitation staff collaborated to establish an evaluation system. We conducted cognitive dysfunction evaluation, driving simulator evaluation, and evaluation at driving schools. Among 160 patients, we evaluated 87 to be fit to drive, and eight to be unfit. We describe the significance and challenges of assessing patients' driving aptitude in primary care.

Objective: This study aimed to investigate the effect of nutritional status on estimated fentanyl absorption in cancer patients being treated with a fentanyl transdermal patch (FP), by measuring the residual fentanyl content in used patches. Methods: 24 adult Japanese inpatients receiving FP treatment for chronic cancer-related pain were enrolled. During FP application, the nutritional risk of the patients was measured using the Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002), both of which are nutrition screening tools used widely in Japan. We then classified the patients into low-, medium-, and high-risk groups according to the nutritional risk measured by MUST, and compared the transdermal fentanyl delivery efficiency (FE) between that groups. Results: The FE, which is estimated by the residual fentanyl content in used FPs collected from the patients, was found to be decreased in the high-risk group. According to NRS 2002, the mean transdermal fentanyl delivery efficiency in the high-risk group was significantly lower than that in the low-risk group. Conclusion: These results showed that changes in nutritional status affect FE, and that poor nutritional status might decrease transdermal fentanyl absorption in cancer patients.

Recent comprehensive investigations clarified that immune microenvironment surrounding tumor cells are deeplyinvolved in tumor progression, metastasis, and response to treatment. Furthermore, several immunotherapeutic trialshave achieved successful results, and the immunotherapeutic agents are available in clinical practice. To enhancetheir demonstrated efficacy, combination of immunotherapy and ablation has begun to emerge. Local ablationshave considerable advantages as an alternative therapeutic option, especially its minimal invasiveness. In addition,local ablations have shown immune-regulatory effect in preclinical and clinical studies. Although the correspondingmechanisms are still unclear, the local ablations combined with immunotherapy have been suggested in the treatmentof several solid malignancies. This article aims to review the published data on the immune-regulatory effectsof local ablations including stereotactic body radiotherapy, cryoablation, radiofrequency ablation, and high-intensityfocusedultrasound. We also discuss the value of local ablations combined with immunotherapy. Local ablations havethe potential to improve future patient outcomes; however, the effectiveness and safety of local ablations combinedwith immunotherapy should be further investigated.

Objective: Distigmine can cause cholinergic crisis as the side effect.  In 2010, the safety information of distigmine was announced and its dosage was changed up to 5 mg per day.  However, the malpractice that a pharmacist dispensed over dose of distigmine caused severe health damages in a community pharmacy.  Therefore, we made the protocol with the urologists for the appropriate use of distigmine, including contents of monitoring the side effects.  The purpose of this study was to measure using the protocol was useful for the propulsion of proper use of distigmine.
Methods: The protocol was introduced in 10 community pharmacies and 1 hospital pharmacy from December 2013 to April 2014, and the patients and pharmacists were filled out the answer to the questions that we have made.  The protocol consisted of five main checks; the dosage, lower urinary tract symptom, presence of renal disease, combined drugs, and signs of the side effects.  Each patient was filled out the checklist given by the pharmacist to monitor the signs of the side effects for 2 weeks.
Results: The 3 prescriptions of distigmine (18.8%) were more than 10 mg per day.  Although 2 patients were confirmed diarrhea and sweating etc., they were mild.  The pharmacists significantly more (p<0.05) answered that the protocol made their motivation to do the pharmaceutical interventions.  All of the patients answered that the pharmaceutical interventions made them relieved.
Conclusion: The use of protocol that we made supported pharmacists to do the pharmaceutical interventions and patients welcome them.

The purpose of this study was to explore the burden of introducing LCP-J in two wards（medical oncology and respiratory medicine）in Tohoku University Hospital. We administered audit evaluations about dying cancer patients and interviewed 2 doctors and 8 nurses regarding LCP-J intervention. LCP-J was used for 22 patients（38％）, and no significant difference in infusion, potent opioid analgesic and sedative medication within last 48 hours were seen between users and nonusers. Responses were categorized into［confirm directions about dying care among health care professionals］, and［training in dying care in a structured way］as usefulness facets of the LCP-J, and［difficulty in assessment of dying］,［burden of health care professionals］, and［difficulty using LCP-J without knowledge and training in dying care］as burdens of the LCP-J. We explored the burden of LCP-J in general wards, and found that use of the LCP-J could need education in dying care and backup of the palliative care team.

This study aimed to elucidate the effects of exercise intensity on stretch-shortening cycle (SSC) function of the lower limbs after cycling. Ten male triathletes performed a cycling graded test to determine the ventilatory threshold (VT) and two hopping-cycling (30 min of cycling at 90 or 110% VT)-hopping tests. The two hopping-cycling-hopping tests performed in random order. Power output (PO), heart rate (HR) and rate of perceived exertion (RPE) were monitored throughout the 30-min cycling. Blood lactate concentrations (BLa) were measured in order to assess metabolic stress. The SSC function was calculated as the ratio of the jump height to the time spent in contact with the ground (reactive strength index [RSI]). PO, HR and RPE values during cycling at 110%VT was higher than at 90%VT (p < 0.01). BLa value after the cycling at 110%VT was higher than at 90%VT (90%VT: 2.4±1.0 vs. 110%VT: 5.9±2.8 mmol/L, p < 0.01). Regardless of the cycling exercise intensity, the RSI significantly decreased after the cycling exercise (p < 0.01). The RSI remained decreased at 15 min after the cycling exercise (p < 0.05). These results demonstrated that the SSC function decreased after cycling. Exercise intensity during cycling is likely to have no effect on the decrease in SSC function.

Purpose: The objective of this study was to investigate whether body fat rate (BFR) and triceps skinfold thickness (TSF) are associated with estimated fentanyl absorption in patients treated with the fentanyl transdermal matrix patch for moderate to severe cancer pain, by measuring the residual content of fentanyl in used matrix patches. Methods: Adult Japanese inpatients experiencing chronic cancer-related pain and receiving treatment for the first time with a transdermal fentanyl matrix patch (Durotep®MT patch) were included in the present study. During the initial application period, BFR was measured using a body fat scale, and TSF was measured by an experienced nurse with an adipometer. One patch was collected from each patient. The residual fentanyl content in used matrix patch was determined by high-performance liquid chromatography. The transdermal fentanyl delivery efficiency was estimated based on the fentanyl content of the used matrix patches. Results: Fifteen adult patients (5 males and 10 females) were included in this study. Nine patches with a release rate of 12.5μg/h and 6 patches with a release rate of 25μg/h were collected. The application site was the chest or upper arm. BFR and TSF both showed a significant positive correlation with delivery efficiency. Conclusion: In malnourished or low-body fat patients receiving DMP, pain intensity should be more carefully monitored, and fentanyl dose adjustment may be required. Additional parameters, such as nutritional status including body fat change, the degree of dry skin, and plasma fentanyl concentration, also require detailed evaluation. Palliat Care Res 2010; 5(2): 206-212

No abstract available.
Aortic Valve Insufficiency* ; Aortic Valve* ; Echocardiography, Transesophageal ; Vena Cava, Inferior*