Introduction: We report two cases of surgery under general anesthesia during cancer pain management of patients with methadone therapy. Case 1: A 57-year-old woman was started on methadone for pain from right breast cancer with multiple bone metastases, and right mastectomy was performed during the course of chemotherapy. There was no exacerbation of cancer pain due to methadone withdrawal, although analgesics were used temporarily for wound pain. Case 2: A 76-year-old man was placed on methadone for pain from lung cancer. There was concern that lower limb paralysis would develop from a compression fracture of the lumbar spine that had occurred during the course of treatment. Therefore, decompression and fixation surgery was performed. Ketamine was used to control intraoperative pain exacerbation, and fentanyl was used by continuous injection for re-exacerbation of pain after the patient had awakened from anesthesia. Conclusion: Since methadone is available only by mouth in Japan and the equianalgesic ratio between methadone and other opioids has not been established, caution is needed for perioperative pain control while oral methadone cannot be administered. Thus, pain and palliative care specialists prescribing methadone are expected to play an active role in adequate perioperative pain control.

Objective：The number of heart failure （HF） patients is increasing in Japan as its population continues to age, but little is known about current medication strategies. We investigated the relationship between medication changes during hospitalization and the readmission rate among older Japanese patients with new-onset HF.Design：Retrospective cohort study.Methods：We analyzed medical record data from Toho University Medical Center Omori Hospital between March 2004 and April 2018. Initial admissions for new-onset HF in patients aged≥75 years were examined (n＝329). The class Ⅰ recommended medications stipulated in the JCS 2017/JHFS 2017 guidelines were used as the target medications for this study. Patients with dose titrations or additions of the target medications during hospitalization (dose titrations or additions group) were compared with patients without these changes (the other group). The primary outcome was readmission due to HF within one year of discharge. A hazard ratio, adjusted for potential confounders, was estimated using a Cox proportional hazards model.Results：There were 231 patients in dose titrations or additions group and 98 patients in the other group.The one-year readmission rate was 26.5％ in dose titrations or additions group and 31.8％ in the other group. The adjusted hazard ratio of medication changes for readmission was 0.82 (95％ confidence interval, 0.51-1.33, P＝0.415), but was not statistically significant.Conclusion：The older HF patients in dose titrations or additions group showed a reduced risk of readmission, but lacked significance due to low statistical power.

BACKGROUND: Long-term management of bronchial asthma based on the fractional exhaled nitric oxide (FeNO) value alone is not conclusive yet. Therefore, we combined FeNO testing and spirometry, a commonly used test in routine practice, to evaluate acute exacerbation and respiratory function in children with bronchial asthma. OBJECTIVE: We combined FeNO testing and spirometry, commonly used in routine practice, to evaluate acute exacerbations and respiratory function in children with bronchial asthma. METHODS: Subjects were school aged children 7 years and older with bronchial asthma who underwent FeNO testing in January 2015 to May 2016. We evaluated the changes in the frequency of acute exacerbations and respiratory function in the 30 subsequent months. Subjects were divided into 2 groups: those with initial FeNO levels ≥ 21 parts per billion (ppb) (high FeNO) and < 20 ppb (normal FeNO) groups. RESULTS: There were 48 children (33 boys) in the high FeNO group and 68 children (46 boys) in the normal FeNO group. Spirometry was conducted on 83 children (72%) prior to the initial FeNO test, revealing no difference in the ratio of detecting lung dysfunction between the 2 groups. The observation period was 25.8 ± 0.7 and 24.7 ± 0.6 months for the high and normal FeNO groups, respectively. The children in the high FeNO group with lung dysfunction in the initial FeNO test continued to exhibit lung dysfunction at the test at 30 months. In the normal FeNO group, even if lung dysfunction was observed at the initial FeNO, it improved within the 20-month point, and the improvement was maintained thereafter. CONCLUSION: Children with bronchial asthma with high FeNO levels and lung dysfunction are at a higher risk of prolonged lung dysfunction.
Asthma ; Child ; Humans ; Lung ; Nitric Oxide ; Spirometry

BACKGROUND/AIMS: Oral mesalazine is an important treatment for ulcerative colitis (UC), and non-adherence to mesalazine increases the risk of relapse. Controlled-release (CR) mesalazine has 2 formulations: tablets and granules. The relative acceptabilities of these formulations may influence patient adherence; however, they have not been compared to date. This study aimed to evaluate the acceptabilities of the 2 formulations of CR mesalazine in relation to patient adherence using a crossover questionnaire survey. METHODS: UC patients were randomly assigned to 2 groups in a 1:1 ratio. Patients in each group took either 4 g of CR mesalazine tablets or granules for 6 to 9 weeks, and then switched to 4 g of the other formulation for a further 6 to 9 weeks. The acceptability and efficacy were evaluated by questionnaires, and adherence was assessed using a visual analog scale. The difference in acceptabilities between the 2 formulations and its impact on adherence were assessed. RESULTS: A total of 49 patients were prospectively enrolled and 33 patients were included in the analysis. Significantly more patients found the tablets to be less acceptable than the granules (76% vs. 33%, P=0.0005). The granules were preferable to the tablets when the 2 formulations were compared directly (73% vs. 21%, P=0.004), for their portability, size, and numbers of pills. The adherence rate was slightly better among patients taking the granules (94% vs. 91%) during the observation period, but the difference was not significant (P=0.139). CONCLUSIONS: CR mesalazine granules are more acceptable than tablets, and may therefore be a better option for long-term medication.
Colitis, Ulcerative ; Drug Compounding ; Humans ; Medication Adherence ; Mesalamine ; Patient Acceptance of Health Care ; Patient Compliance ; Prospective Studies ; Recurrence ; Tablets ; Ulcer ; Visual Analog Scale

BACKGROUND/AIMS: Mesalazine is an effective drug for treating ulcerative colitis (UC), but causes allergic symptoms in a few cases. Therefore, the objective of this study was to evaluate the usefulness of the drug-induced lymphocyte stimulation test (DLST) for the diagnosis of mesalazine allergy. METHODS: Patients with UC treated with mesalazine with or without a history of associated adverse events (AEs) were enrolled at Kyorin University Hospital from July 2016 to April 2017. RESULTS: The DLST was performed in 104 patients with UC, of which 24 had a history of AEs due to mesalazine treatment. The control value of DLST was 337.4±296.3 counts per minute (cpm) in the AE+ group and 408.0±371.9 cpm in the AE− group. The measured value of DLST was 578.8±424.7 cpm in the AE+ group and 476.5±471.8 cpm in the AE− group. The stimulation index (SI) was 243.9%±291.1% in the AE+ group and 119.8%±53.0% in the AE− group. The SI value and DLST positivity were significantly higher in the AE+ group than in the AE− group (P=0.030 and P=0.029, respectively). The test sensitivity and specificity were 0.240 and 0.805, respectively, and the false-positive and false-negative rate was 0.195 and 0.760, respectively. CONCLUSIONS: The DLST for mesalazine showed low sensitivity and high specificity, suggesting that it may be useful for the definitive diagnosis of allergy to mesalazine.
Colitis, Ulcerative ; Diagnosis ; Humans ; Hypersensitivity* ; Lymphocyte Activation* ; Lymphocytes* ; Mesalamine* ; Sensitivity and Specificity

Previous study reported that patients of institutions with religious background are more likely to achieve ‘good death’ than patients in non-religious institutions, although the reasons are unclear. This study aims to examine the reasons for this difference using a national survey of religious and non-religious institutions. We sent a self-administered questionnaire to 10,715 bereaved family caregiver and 133 hospice and palliative care units which cared for their family members prior to death. The questionnaire for bereaved families included the Good Death Inventory (GDI). The questionnaire for institutions included their religious affiliation and their subjective and objective provided care. In total, 7,286 bereaved families (68%) and 127 (95%) institutions including 23 religious end-of-life care institutions responded. We performed t-test and χ-square test to compare the GDI scores and provided care for religious and non-religious end-of-life care institutions. The GDI total score was significantly higher (p=0.01) in religious institutions compared to non-religious institutions. Items such as “providing many activities for seasonal events to the patients”, “providing more bereavement care”, “having facilities to practice their religion”, and “having regular visits from religious leaders”, were all reported more frequently in the religious institutions, and significantly associated with achievement of ‘good death’ (p<0.05 for all items). This study suggests that factors for achieving ‘good death’ are not only limited to providing religious care but also providing other forms of care, services, and activities that can enhance the patients’ ‘good death’.

1）Palliative care education by means e–learning was performed from December 3 to 25, 2009, for 1256 hospital medical staff. We used the same true–or–false questions to assess their understanding before and after the e–learning course.
2）Regardless of the staff member’s experience, the total scores on the test were higher after the course than before the course. Therefore, this e–learning course had an effect on basic knowledge for multiple types of medical staff.
3）The percentage of correct answers was particularly improved for questions about topics we had emphasized: drug dependence and side effects.

Purpose: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. Methods: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. Results: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. Conclusion: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227