The conventional crushing method for administration of drugs to patients with feeding tubes has been commonly used at the Hyogo College of Medicine College Hospital. Compared with this conventional method, the simple suspension method can reduce drug degradation due to light and moisture absorption as well as avoid drug loss and contamination. We conducted a workshop to introduce this method to pharmacists. We asked the participants to fill a questionnaire-based survey both before and after the workshop to determine the effects of the workshop on the change in the degree of awareness among participants about these methods. The awareness of participants about the simple suspension method was approximately 80% before the workshop. Approximately 60% of participants answered that they had questions about simple suspension method from individuals from other occupations, suggesting a high awareness of this method. After the workshop, approximately 98% of participants answered that they were “satisfied” or “slightly satisfied,” suggesting that they were in favor of introducing the suspension method. The results of text mining indicated a requirement for participants to consider incompatibilities and to educate the nursing department. Participants who actively considered the proposal of simple suspension method had an altered perception toward the introduction and utilization of this method. Therefore, this survey suggested that workshops could alter the perception and behavior of pharmacists about the methods of drug administration via feeding tube.

　　The aim of this study was to examine topophilia in the elderly living in mountainous areas. Topophilia, which is the geographical concept invented by Yi-Fu Tuan in 1999, is defined as the affective bond between people and place or environmental setting. A total of 120 elderly subjects living in a mountainous area responded to a standardized, validated 9-item Life Satisfaction Index K (subjective well-being) developed by Wataru Koyano and a new structured 6-item questionnaire on topophilia. Factor analyses revealed two domains of topophilia (public emotion and private emotion toward the living place). Public emotion was the emotion of being hard to leave the living place. Private emotion was the emotion of not loving the living place. There were areas where the elderly had a lesser degree of attachment toward the present state of the elderly could hardly have a sense of well-being and attachments to the current domicile. It is considered that not only physical but also mental approach is necessary to support the daily life of the elderly living in the mountainous area. Also, we examined the influences of aging and the living place on a subjective well-being and topophilia. There was no significant correlation between age and subjective well-being, but there was significant positive correlation between age and the degree of topophilia (r＝0.234, p‹0.01). On the other hand, the degree of subjective well-being by the place of residence was significantly different (p‹0.001; ANOVA), and the degree of topophilia by the place of residence was not significantly different. These findings suggest that subjective well-being is not influenced by age but influenced by the place of residence, and topophillia is not influenced by the place of residence but influenced by age.

　　It is often reported that the number of cases of cervical spinal cord injury without fracture resulting from falls have increased in recent years with a aging population.　　We reviewed the cases of cervical spinal cord injury in the patients who were admitted within two days after the injury to our department between January 2006 and December 2012, The subjects of this study numbered 167 cases;129 males and 38 females. The frequency of occurrence of cervical spinal cord injury, according to reports by the fire departments in the southwestern part of Ibaraki Prefecture is 32.0 per million individuals per year. In our cases under review, fractures were noted in 72 individuals, whereas 95 had no fractures. As to the causes of injury, traffic accidents topped the list with 38.9%, followed by falls with 28.7%, stumbles with 20.4%, and other factors with 12.0%. Cervical spinal cord injury account for 75% of all the cases of spinal cord injury with an incident of 30-40 cases per 100 million individuals per year. In 2011, the incidence of cervical spinal cord injuries resulting from traffic accidents decreased, while that of injuries related to falls increased. Six cases of injury resulting from falls happened during repairs on the damaged houses in the aftermath of the Great East Japan Earthquake of March 2013.

  We examined how difficult it would be for the elderly living in mountainous areas to go to the nearest hospital using a Voronoi tessellation representing the mathematical concept of neighborhood. We defined the index of the nursing-care capacity for the elderly as the ratio of the number of caregivers to the number of the elderly receiving nursing-care.
  The mean age of those who drive to the hospital by themselves worked out at 70±9.8 years. Meanwhile, that of those who go to the hospital by bus or taken to hospital in a car driven by a family member came to 80±7.0years. The latter was significantly older than the former.
  The areas of the Voronoi tessellation generated by patients' places of residence were divided into three groups according to the size. The plots of these three groups of the the places of residence on the map had a three-layer and doughnut-like structure, i. e., inner-, middle-, and outer-layer.
  The index of the nursing-care capacity in 2008 was less than 1.0 for the patients under 80 years of age. This means that when those who were at the age of 50 in 2008 become old and need nursing-care, access to the hospital will become harder to them than at present. For those who are over 80 years of age and live in the outer layer that is far away from arterial road, it will be almost impossible.
  These findings suggest that outpatient care with transportation assistance by a family member at present should be reconsidered because of the future lack of care personnel. It would also be necessary to consider the welfare of older people from the geographical point of view in order to manage the problems concerning the various physical and sociological difficulties of the elderly.

Purpose: Escitalopram has been inadequately evaluated in cancer patients. Here, we report two patients with advanced cancer who benefited from escitalopram for depression. Case 1: A man aged in his 50s had postoperative recurrence of rectal cancer. He was diagnosed with a major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The score of the Hamilton Rating Scale for Depression (HAMD-17) was 20 points. He began treatment with 10 mg/day of escitalopram. His symptoms began to improve at about 14 days, and the HAMD-17 score was 4 points at 23 days, suggesting a marked improvement. Case 2: A woman aged in her 50s had cancer of the external auditory canal. She was diagnosed with a major depressive episode according to DSM-IV-TR. The score of HAMD-17 was 26 points. She began treatment with 10 mg/day of escitalopram. Her symptoms began to improve at 15 days, and the HAMD-17 score at 28 days was 13 points, suggesting a marked improvement. In both cases, serious side effects, clear exacerbation of depression, and withdrawal syndrome due to acute drug deprivation associated with worsening of the symptoms were not noted. Conclusion: Escitalopram is considered a useful drug for depression in patients with advanced cancer.

When patients hospitalized in a palliative care unit die, particularly when their deaths were not peaceful ones, we, as health professionals, feel distressed, senses of helplessness and defeat, and even regret. However, busy daily clinical practice usually does not allow us to express these feelings. After going through such an experience repeatedly, your self-efficacy may be reduced and you could feel burned out. In this study, through the experience of coping with the death of a liver cancer patient who died of necrotizing fasciitis resulted from bedsore, a death conference was organized for us, health professionals who had been directly concerned with the patient, to discuss questions, conflicts, and dilemmas that arose when we provided care and express feelings that had been repressed. And other participants in the conference, who had not been directly concerned with the patient, gave their affirmative views. The conferences served to: (1) promote mutual understanding, trustful relationships, and teamwork among us, (2) increase our awareness of palliative care, and (3) allow us to cope with stress and prevent us from feeling burned out. These effects are considered to help implement improved health care. In the former part of the conference remarks were divided into three categories, (1) regret, (2) questions, conflicts, and dilemmas, and (3) senses of helplessness and defeat, and in the latter part affirmative views were mainly stated.

Objective: The hospital is changing its formulary reference from paper-based to intranet.  There was concern that both paper-based and intranet versions of the formulary would be necessary.  Revising the paper-based hospital formulary each time package inserts are revised is difficult.  For your review we report on the creation of the iPhone® electronic formulary which enables rapid off-line formulary retrieval and easy updates while at the same time providing low cost service in a light device.
Methods: The CSV (Comma Separated Value) of the hospital formulary dictionary was made using a standard personal computer.  The CSV data file was converted using JAMES2DIC into a HTML file format.  Next, the converted HTML file is transformed into the EPWING (Electronic Publishing WING) format using EBStudio.  Finally, we forward the EPWING dictionary file from the personal computer to the iPhone®.  The retrieval becomes possible by using EBPocket for iOS of EPWING/electronic book viewer software for the iPhone®.  The number of items was assumed to be 29 items thought for a lot of inquiries to exist.
Results: We compared the paper-based formulary with the iPhone® electronic formulary.  As a result, the iPhone4® electronic formulary shortened the retrieval time, was smaller, lighter, and excellent at a lower price.
Conclusion: The iPhone4® electronic formulary enables the user to perform complex full-text searches and retrieve information at a much higher speed than is possible with paper based formularies.  It has the additional advantage of seamless integration and deployment of formulary additions or reference material revisions.  We believe we have successfully created a practical electronic formulary.

The injury mechanism of traumatic cervical spine injury varies, and Allen et al. divide cervical spine injuries into 6 types based on the direction of external force at the time of injury. In this report, we present 2 cases as Lateral Flexion Stage 2. A 51-year-old male (Case 1) was injured in a traffic accident. His conscious level was JCS III-200, and he was found to have a Frankel Grade of B. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We were unable to obtain good reduction. We planned to perform posterior fusion using a cervical spine pedicle screw but could not perform the procedure due to the patient’s poor general condition. A 32-year-old male (Case 2) was injured as a result of being hit by a steel sheet. He had Frankel Grade D paralysis. X-ray revealed a C5/6 fracture dislocation injury of Lateral Flexion Stage 2. We did not perform manual reduction. We performed posterior fixation, anterior decompression and anterior fixation. Bone union was confirmed, and the patient was able to return to work. In cases of this type of fracture dislocation of the cervical spine, the supporting structures of the spinal column circumferentially rupture and induce high instability. Since closed reduction is sometimes difficult and involves risk, strong internal fixation might be recommended.

It is not uncommon for edema in the end stage of advanced cancer to be caused by nephrotic syndrome (NS) as well as by cachexia, hypo-proteinemia due to malnutrition, or lymphedema. Such edema not only causes patients' quality of life (QOL) to be deteriorate, but may also result in earlier death in the absence of accurate diagnosis and treatment. We report a case of nephrotic syndrome with advanced uterine cancer, in which the patient's QOL was greatly improved by the accurate and timely diagnosis and treatment of NS. A 65-year old woman suffering from recurrent uterine cancer (lung and brain metastases) was admitted as an emergency due to deterioration of her general condition. Edema of both legs was severe, and laboratory findings (TP 5.0 g/dl, ALB 1.3 g/dl, T-Chol 369 mg/dl, proteinuria 3+) at the time of admission met the diagnosis criteria for NS rather than cachexia. We first administered albumin to stabilize circulation, and started treatment with prednisolone and cyclosporine, which greatly improved her general condition and edema of her legs. Subsequently, NS repeatedly improved and worsened and the tumors gradually progressed. The patient died of multiple organ failure induced by disseminated intravascular coagulation (DIC) at 81 days after admission. NS caused by malignancy is not uncommon. In general, however, such cases of NS are associated with solid tumors, such as gastrointestinal and lung cancer. NS caused by uterine cancer is very rare. We suggest that NS should be borne in mind in addition to cachexia, hypo-proteinemia or lymphedema as a possible cause of edema in the end stage of advanced cancer. Palliat Care Res 2011; 6(1): 316-323

A 59-year-old man with myocardial infarction underwent 4-vessel coronary artery bypass grafting. After operation, on the 9th hospital day, fever, dehiscence of the median wound, and pus discharge were observed. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in the wound, and median wound curettage and removal of the sternal bone wire were performed. The infection also involved the substernal area and anterior mediastinum, and a diagnosis of mediastinitis was made. After wound cleansing and antibiotic (vancomycin) administration, inflammatory reactions decreased, and MRSA disappeared from the wound. The wound spontaneously closed, and complete closure required 60 days. On the 75th hospital day, pain from the right shoulder to the neck and numbness in the upper limbs suddenly developed. MRI revealed vertebral body destruction at C5-6, and a diagnosis of cervical osteomyelitis was made. The spinal cord was compressed, and there was a risk of spinal cord injury below the cervical spine. After consultation with orthopedic surgeons, cervical anteroposterior fixation was performed, he improved, and was discharged. We report a patient with MRSA mediastinitis complicated by cervical osteomyelitis who required emergency surgery.