Objective: To investigate the effectiveness and safety of continuous infusion of midazolam for the treatment of headache and/or nausea/vomiting in patients with brain tumors or cancer-associated meningitis. Methods: Patients who presented with headache and/or nausea/vomiting and underwent continuous infusion of midazolam from April 2005 to March 2021 were retrospectively analyzed. Results: Among 22 patients, 19 presented with headache and 14 with nausea/vomiting. The success rate of continuous infusion of midazolam for headache was 89% and that for nausea/vomiting was 78%. The mean number of vomiting episodes within 24 hours from the start of midazolam administration was 0.14±0.36, which was significantly lower than that from 24 hours before to the start of administration (1.43±1.60, P=0.015). Sedation was observed as an adverse event in five (23%) patients, but no patients developed respiratory depression. Conclusion: When conventional therapies are ineffective for headache and/or nausea/vomiting caused by brain tumors or cancer-associated meningitis, continuous infusion of midazolam may improve symptoms and should be considered as a treatment option.

Objective: The wrong dose of high-risk drugs such as oral steroids is a serious issue that needs to be addressed. This study aims to determine the appropriate upper tolerable dose threshold and to develop a multi-variable logistic regression model to detect dose-errors in oral prednisolone tablets.Methods: Data on Prednisolone prescriptions were obtained from a single center. Out of the data collected, positive cases consisted of cases where dose-related modifications were made. A univariate logistic regression model was developed with the current daily dose. In the model, the Youden Index was used to determine the upper tolerable dose threshold. The investigation was done to determine whether the performance of the multivariate model was improved by adding clinical department and previous prescription information as variables.Results: Univariate models (AUC: 0.645) with only current daily doses and estimated optimal thresholds of 6 mg/day or 11 mg/day, respectively were determined to be appropriate. Including variables improved the performance of the predictive model; the best performing model (AUC: 0.840) was derived when the following variables were entered: “current daily dose,” “current prescription days,” “clinical department,” “daily dose of the previous prescription,” and “prescription days of the previous prescription”.Conclusion: A single upper tolerance limit is insufficient to determine dose adequacy for prednisolone tablets owing to their broad clinical dose range. Itmay be possible to develop a high-performance dose audit support model by adding information.

Team-based learning (TBL) is an educational method developed to cultivate the ability to solve problems by learning and applying knowledge on one's own, as well as the ability to make decisions, take responsibility, and collaborate by working on issues in small groups. TBL in Kampo medicine was held as a special program : active learning at the 71st Annual Meeting of the Japan Society for Oriental Medicine. A total of 57 students participated in the TBL session. The theme of the session was the common cold with the theory of yin and yang. According to the results of a questionnaire survey, the students answered that they were able to understand the flow of diagnosis in Kampo medicine, which was the goal of the course. As a bridge from classroom lectures to clinical practice, TBL in Kampo medicine was considered to be useful in Kampo medical education.

To help medical doctors practicing Kampo medicine suggest appropriate acupuncture treatments for individ­ual patients, a study group made up of 7 acupuncturists and 5 medical doctors developed an acupuncture cur­riculum. The group provided a learning program based on the curriculum for 16 medical doctors in charge of outpatient Kampo services in a research institute. The learning program consisted of a lecture and practical training, and a total of 4 sessions were held. At the end of each session, a test was conducted to examine the participants' level of understanding. After the completion of the learning program, a questionnaire survey was conducted to confirm the usefulness of the acupuncture curriculum for the practice of Kampo medicine. The mean number of participants per session was 10.8 ± 1.3. The mean test score was 9.3 ± 0.5 (full score : 10). In the questionnaire, 14 out of the 16 (88%) answered that the acupuncture curriculum was useful or relatively useful for the practice of Kampo medicine. On comparing the numbers of new acupuncture patients with a his­tory of outpatient Kampo service use before and after the acupuncture curriculum, there was a 1.8-fold increase after it. The results support the usefulness of the acupuncture curriculum to understand acupuncture and practice Kampo medicine. Further evaluation is necessary.

Introduction: several clinical training hospitals have their own resident mentor systems in Japan. However, the details and effects of the system still remain unclear.　Objective: The aim of this study is to introduce Okayama University Hospital’s resident mentor system and to investigate its effectiveness based on mentees’ evaluations.　Method: A questionnaire survey was conducted on residents using the system.　Results: 32 (78.0%) of 41 residents used the system. 28 (87.5%) of them completed the survey, indicating most residents were satisfied with the currently-used system.　Discussion: We will conduct a more detailed questionnaire survey for mentors and mentees to further improve the resident mentor system.

An oropharyngeal cancer patient often suffers from dysphagia either due to their disease or as a conse­quence of their treatment. Here we report a case of a 61-year-old female with the oropharyngeal cancer-related dysphagia, which was effectively treated with Kampo medicine. After four weeks of treatment with hangekobokuto, her swallowing function was improving. Concomitant use of bakumondoto reduced a feeling of xerostomia. She could return to work. The treatment with Kampo medicine might be effective to reduce the cancer-­related symptoms and to improve the quality of life of the cancer patients.

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.

We treated a pediatric patient suffered from anxiety disorder with ogikenchuto in combination with Western medicine. The case was a teenage girl with long-term neck pain. After entering junior high school, she had palpitations and was afraid while interacting with other students, experienced headaches, struggled to get out of bed in the morning, and developed anorexia and dizziness upon standing up. She was diagnosed with anxiety disorder and orthostatic dysregulation (OD) associated with autistic disorder at a pediatrics department. Pediatricians prescribed aripiprazole and midodrine hydrochloride. And she was referred to our department for treatment with Kampo medicine. Her condition was presumed to be various deficiencies with kikyo, kigyaku, suitai, and kankikyo. She was prescribed 9 g of ogikenchuto extract per day, and the symptoms improved. Kankikyo should be considered for OD patients with psychosomatic symptoms, and ogikenchuto may be one of the prescription drugs for such condition.