Dominant dystrophic epidermolysis bullosa (DDEB) is a rare inherited skin disorder characterized by extreme fragility of the skin and mucosa that poses significant challenges for anesthetic management. Herein, we report a case of a 65-year-old woman with DDEB who underwent a 13-hour surgery for mandibular cancer under general anesthesia. To prevent skin and mucosal injuries, meticulous perioperative strategies were implemented, including the use of barrier films and pressure-relieving pads and avoiding adhesive devices. High-flow nasal cannula oxygenation enabled awake fiberoptic intubation without the need for mask ventilation, minimizing the risk of blister formation and airway trauma. Despite the prolonged duration, no pressure ulcers or new skin injuries developed, other than minor epidermal peeling of the lips. This case demonstrates that comprehensive preoperative planning and intraoperative protection can ensure safe anesthesia in patients with DDEB undergoing long surgical procedures.

Saiseikai Yokohama-shi Nanbu Hospital has been charging an additional fee for enhanced collaboration for surgical patients concerning outpatient cancer drug chemotherapy since March 2022. In this survey, we compared the number of consultations and pharmacological interventions performed by pharmacists for target and non-target departments from September 2021 to February 2022 before the calculation began, and from March to August 2022 after the calculation started. In the target department, the number of consultations was 1.5±1.3 and 8.1±4.8 per day for before and after the calculation began, respectively, showing a significant increase (P<0.001). The number of pharmacological interventions increased from 35 preoperatively to 66 postoperatively. However, in the non-target departments, there was no change in the number of consultations and pharmacological interventions between before and after the calculation started. The results suggest that the additional fee for enhanced collaboration effectively enables pharmacists to continuously intervene in pharmacological problems.

  One of the characteristics of nursing in Southeast Asia is the ASEAN Mutual Recognition Arrangements on Nursing Services, which strengthens professional capabilities through four objectives include facilitating mobility of nursing professionals within ASEAN.  The Japanese government supports human resources for health in the ASEAN region, as a member country of ASEAN+3. A meeting was held at the Annual Meeting of the Japan Association for International Health 2017. The meeting objectives were as follows: (1) to share three nursing research findings regarding nursing migration, regulatory framework, and in-service training that may affect quality of nursing and (2) to discuss Japan’s role in improving the quality of nursing in the ASEAN region. This report aims to summarize the presentations and points of that meeting.   The academic level of nursing education and nursing regulations have improved in ASEAN member countries. All member countries have university nursing education, and some have master’s and doctoral degree nursing programs. In lower middle income ASEAN countries, such as Cambodia, Laos, and Vietnam, the nursing education system is in the process of transition, from the technical to professional level of nursing. The next step for these countries is to strengthen the capabilities of nursing teachers who are responsible for professional nursing education at universities. The ASEAN University Network and universities in neighboring Thailand could also contribute to this end. In-service training is also needed because the guidance of more experienced nurses is crucial in nursing service as well as nursing practicums. Japan’s experience of developing an in-service training system could be useful for some ASEAN countries.   The objective of mobility among nursing professionals within the ASEAN has yet to be accomplished. However, there are pull and push factors of nurse migration due to economic conditions within the ASEAN. It is predicted that nurse migration will occur with mixed-skill caregivers to high income countries out of the ASEAN countries, because of the lack of caregivers for the aging population. In order to ensure quality nursing in the ASEAN region, it is not only necessary to share country-level experiences to improve nursing education and regulations but also crucial to develop systems that promote the circulation of nursing professionals through wide regional cooperation.