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.

Introduction: The career support system was introduced in Okayama University Hospital in 2008, and the number of users has exceeded 150. Methods: To examine changes in perceptions of the system and its users, we conducted a questionnaire survey of supervisors and the colleagues of system users in FY2011 and FY2018. Results: Compared to 2011, the following items were significantly higher in FY2018: "I have experience working with users of the support system", "I think this system is useful for the medical office", and "This system makes the medical office more appealing". In the analysis of the colleagues of system users only, in addition to the aforementioned three items, the item "Users of the system are able to do their jobs to the degree expected" was significantly higher in FY2018. Conclusion: The effectiveness of the career support system is becoming more recognized, and the evaluation of the work content of the system's users has improved.

Objective: In this study, we aimed to develop a new system that can centrally manage and share drug information, and also evaluated its usefulness.Methods: Using PHP v5.3.3 as the programming language and MySQL v5.1.73 as the database, we built a web application that constantly runs on the server. Various drug information was registered in this system, and its usage status was analyzed based on the access log.Results: The system was accessed 31,678 times during the survey period (October 1 to December 31, 2019). The information sought included: basic drug information (ordering category of drugs, dosage forms and strengths, drug price, etc.) (13,962 times, 44.1%),question and answer records (7,221 times, 22.8%), pharmaceutical documents (package inserts, interview forms, documents regarding compatibility of injections, etc.) (7,172 times, 22.6%), notifications regarding new and discontinued drugs (727 times, 2.3%), websites (676 times, 2.1%), PreAVOID reports (663 times, 2.1%), pharmaceutical safety information (525 times, 1.7%), information regarding off-label drug use (409 times, 1.3%), and bibliographic information and guidelines (323 times, 1.0%). Among the users (62 pharmacists), 59.7% accessed the system only via a personal computer (PC), 38.7% via a PC and smart device (smartphone or tablet),and 1.6% via only a smart device. The median number of accesses to this system was significantly higher in pharmacists in charge of wards (190 [9-1,435]) or drug information (3,750 [2,957-5,548]) than dispensing pharmacists (68.5 [3-193]) (p＜0.001).Conclusion: This system allowed the central management and sharing of various drug information on the web, permitting access regardless of device type. Since this system was frequently used by pharmacists in charge of wards or drug information, this system was considered particularly useful in hospital pharmacist ward services and drug information services.

BACKGROUND/OBJECTIVES: Taste perception is influenced by both nutritional factors and psychological factors. This study was undertaken to measure the 4 basic taste perceptions, nutrient intake, and mental health, and to examine the factors that affect insensitive taste perception in young Japanese women. SUBJECTS/METHODS: Young women in their late teens and twenties were enrolled as subjects. Taste perception was measured by applying the filter-paper disc method over areas of the chorda tympani nerve. Nutritional status was evaluated using brief, self-administered diet history questionnaires. The index of nutritional status was based on the 2015 Japanese dietary reference intakes. Mental health was assessed using the Japanese translation of the Profile of Mood States short version. This study was approved by the ethical committee at Osaka University. RESULTS: The normal taste perception group (four basic tastes [sweet, salty, sour, and bitter] identified as normal taste perception) comprised 55.4% of the subjects, while the abnormal taste perception group (more than 1 abnormal taste perception was perceived, regardless of flavor) comprised 44.6% of the subjects. There were no significant differences in nutrient intake (except manganese) and mental health between the normal and abnormal taste perception groups. Subjects who took 5 mg to less than 7.1 mg zinc per day were at significantly decreased risk of insensitive taste perception compared to subjects who consumed less than 5 mg zinc per day [Regression coefficient 0.831, 95% confidence interval 0.694–0.996]. CONCLUSION: The present results suggest that insensitive taste perception could be associated with zinc deficiency in young women in their late teens and twenties.
Adolescent ; Asian Continental Ancestry Group ; Chorda Tympani Nerve ; Diet ; Female ; Humans ; Mental Health ; Methods ; Nutritional Status ; Psychology ; Recommended Dietary Allowances ; Taste Perception ; Zinc

　　In this study, to establish a system unique to our hospital, an awareness survey of physical therapists was conducted using a newly developed form to investigate the degree of anxiety about, and participation in supporting, pediatric patients with a developmental disorder, managing patients’ families, and interdisciplinary cooperative activities. The level of anxiety and the degree of participation were evaluated using a visual analog scale. The Mann-Whitney U test was used to compare cooperative activities with different professionals. The results showed that 20 (90.9%) of the physical therapists were anxious about supporting and handling pediatric patients with a developmental disorder and their families. No significant difference in the degree of anxiety was observed among different professionals, but the highest anxiety was observed when working in cooperation with physicians (Dr), followed by clinical psychotherapists (CP), nurses (Ns), medical social workers (MSW), occupational therapists (OT), and then speech therapists (ST). Physical therapists cooperated most frequently with Dr, followed by Ns, OT, MSW, ST, and then CP, with a significant difference between Dr and CP. The findings of this study, showing current awareness and challenges related to pediatric patients with a developmental disorder, provide information that is fundamental for the establishment of a system unique to our hospital.

BACKGROUND: The immunological mechanisms of asthma remission remain unclear although several reports have suggested that balance between T helper (Th) 2 cytokines and regulatory cytokines is related. OBJECTIVE: To study the balance between interleukin (IL) 10 and IL-5 in asthma clinical remission. METHODS: We measured the numbers of IL-5 and IL-10 producing cells in peripheral blood mononuclear cells stimulated with mite antigen obtained from patients with active asthma (group A, n = 18), patients in clinical remission (group R, n = 15) and nonatopic healthy controls (group H, n = 14). RESULTS: The numbers of IL-5 producing cells in groups A and R were significantly higher than in group H. The number of IL-5 producing cells was lower in group R than in group A, although the difference was not statistically significant. The number of IL-10 producing cells was higher in group R than in group A, although again the difference was not statistically significant. There was a significant difference in the number of IL-10 producing cells between groups A and H but not between groups R and H. The ratio of the number of IL-10 to IL-5 producing cells was highest in group H followed by groups R and A, and the differences were statistically significant for each pair of groups. CONCLUSION: Our study suggests that the IL-10/IL-5 balance is related to clinical asthma. The balance differs between patients in clinical remission and healthy controls, suggesting that allergic inflammation may continue even after clinical asthma remission.
Asthma ; Child ; Cytokines ; Humans ; Inflammation ; Interleukin-10 ; Interleukin-5 ; Interleukins ; Mites ; Prognosis

Background: Urosepsis is a potentially fatal syndrome that is sometimes difficult to diagnose. Thus, the aim of the present study was to clarify the clinical and laboratory characteristics and pitfalls in the diagnosis of urosepsis.
Methods: We enrolled the study participants based on clinical records of patients with urosepsis treated between January 2009 and April 2012 inclusive, in the Department of General Internal Medicine, Toyama University Hospital and retrospectively surveyed underlying diseases, clinical symptoms, physical findings, and laboratory data, respectively.
Results: Ten definitive patients were selected (nine females and one male; age, 55–86 years). Fever was the most frequent symptom followed by nausea. Lower back pain was the chief complaint in only two patients. One patient complained of dysuria, and on examination half of the patients lacked costovertebral angle (CVA) tenderness. Five patients showed elevated liver enzymes without evidence of hyperbilirubinemia.
Conclusions: There were no specific clinical characteristics of urosepsis, and symptoms in some patients resembled digestive diseases such as cholangitis. Our results demonstrate that use of dipstick urinalysis and microscopic urinalysis are essential for the diagnosis in patients with sepsis. Abdominal ultrasonography and/or computed tomography should also be considered to rule out false negative results of urinalysis related to urinary tract obstruction, and to detect other focal infections when appropriate.

Europe has a long history with its own traditional medicines. In Germany, the practice of traditional European and Asian medicine along with modern medicine is called Integrative Medicine. The pain clinics at Munich University, TCM Klinik Bad Kotzting, Immanuel Klankenhaus and Zen Haus Klinik are well-known centers of Integrative Medicine in Germany. We visited these hospitals and clinics and report on the state of their treatment.
Four-week programs in chronic pain, traditional Chinese medicine, natural therapy, and traditional Japanese medicine with aromatherapy are given at these facilities. Moreover, Complementary and Alternative medicines are widely covered by public or private insurance. And one reason for the spread of Integrative Medicine may be these social conditions, in addition to historical background.

Recent progress in chemotherapy has prolonged the survival of patients with malignant biliary strictures, leading to increased rates of stent occlusion. Even we employed metallic stents which contributed to higher rates and longer durations of patency, and occlusion of covered metallic stents now occurs in about half of all patients during their survival. We investigated the complication and patency rate for the removal of covered metallic stents, and found that the durations were similar for initial stent placement and re-intervention. In order to preserve patient quality of life, we currently recommend the use of covered metallic stents for patients with malignant biliary obstruction because of their removability and longest patency duration, even though uncovered metallic stents have similar patency durations.
Biliary Tract Diseases/*surgery ; Coated Materials, Biocompatible ; Device Removal ; Drainage/methods ; Endoscopy ; Foreign-Body Migration/surgery ; Humans ; Metals ; Postoperative Complications/surgery ; *Stents/adverse effects