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.

Objectives: Safety reports are core components of secure medical systems, but their significance have remained obscure, mostly owing to limited quantitative approaches other than the numbers of reports. In 2005, we developed “management levels” and their equally converted points (p) of scores, which indicated the grades of required correspondences of medical systems. Moreover, products of those scores multiplied by risk levels (equally converted scores), “total scores” were also proposed for weighting harmful events from biphasic aspects; severity of patient damage and the required levels of correspondence as medical systems. In this study, we assessed this scoring system using extensive longitudinal experience.Methods: Risk, management and total scores were retrospectively surveyed between 2012 and 2022 when a consistent reporting system had worked throughout the study period.Results: The aforementioned three scores inconsistently decreased along with a decrease in number of safety reports from 2,445 to 1,194 cases, or 2,069 to 1,052 cases/105 admitted patients (c/pap) in eleven years. Of the scores, the most prominent decrease was found in the management scores from 2,164 to 1,070 points/pap (p/pap). The risk and total scores had decreased even more modestly: from 1,879 to 1,484 p/pap, and 5,470 to 4,007 p/pap, respectively. When compared with the proportion (%) of risk and management levels in 2012, risk level 0 decreased, and risk level 1 and 3a increased in 2022. However, the proportion of management levels did not change during this period.Conclusion: The proposed scoring system showed that the cumulative severity of patient damage did not worsen, or decrease in some years accompanied by decreasing correspondence levels of the medical system, although the numbers of reports also decreased. These findings show the appropriateness of the on-going safety activities of this hospital even when restricted to reported events. However, their effectiveness including unreported events, requires further study.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.

Purpose: External rectal prolapse (ERP) is frequently associated with other pelvic disorders, such as enterocele, rectocele, and perineal descent. Evacuation proctography makes it possible to visualize the development of such anatomical abnormalities. The aim of this study was to identify the variables that would predict associated abnormalities in patients with ERP. Methods: Between February 2010 and August 2019, 124 female patients with ERP, who were evaluated using proctography were included in this study. Enterocele was diagnosed when the extension of the loop of the small bowel was located between the vagina and rectum. A significant rectocele was defined as >20 mm in diameter. Multivariate analysis was used to establish which morphological parameters best predicted the presence of enterocele or rectocele. Results: Sixty-five patients had ERP alone, while 59 patients (47.6%) had additional findings on proctography. The most frequently associated abnormality was enterocele with 48 of the patients (38.7%) having this condition. Rectocele was detected in 17 of the 124 patients (13.7%). The median length of the ERP was 30 mm (range, 7 to 147 mm). The results of the stepwise multiple regression analysis showed that a history of hysterectomy and the length of the ERP were significantly associated with the presence of enterocele. The analysis showed that the longer the prolapse, the higher the incidence of enterocele. A history of hysterectomy was also significantly associated with the presence of rectocele. Conclusion Patients with ERP often have associated anatomical abnormalities and should be investigated thoroughly before planning surgical treatment.

Purpose: External rectal prolapse (ERP) is frequently associated with other pelvic disorders, such as enterocele, rectocele, and perineal descent. Evacuation proctography makes it possible to visualize the development of such anatomical abnormalities. The aim of this study was to identify the variables that would predict associated abnormalities in patients with ERP. Methods: Between February 2010 and August 2019, 124 female patients with ERP, who were evaluated using proctography were included in this study. Enterocele was diagnosed when the extension of the loop of the small bowel was located between the vagina and rectum. A significant rectocele was defined as >20 mm in diameter. Multivariate analysis was used to establish which morphological parameters best predicted the presence of enterocele or rectocele. Results: Sixty-five patients had ERP alone, while 59 patients (47.6%) had additional findings on proctography. The most frequently associated abnormality was enterocele with 48 of the patients (38.7%) having this condition. Rectocele was detected in 17 of the 124 patients (13.7%). The median length of the ERP was 30 mm (range, 7 to 147 mm). The results of the stepwise multiple regression analysis showed that a history of hysterectomy and the length of the ERP were significantly associated with the presence of enterocele. The analysis showed that the longer the prolapse, the higher the incidence of enterocele. A history of hysterectomy was also significantly associated with the presence of rectocele. Conclusion Patients with ERP often have associated anatomical abnormalities and should be investigated thoroughly before planning surgical treatment.

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.

JA Omagari Kosei Medical Center is an acute hospital located in Daisen City, Akita Prefecture, and we have two comprehensive community-based care wards. Falls and fall incidents are always ranked high in acute hospitals. Injuries caused by falls such as fracture, may lead to decline in activities of daily living / quality of life in patients and / or their families, which may then prolong the hospitalization period. Therefore, prevention of falls and falling is beneficial. Previous studies have reported that the activities of the ‘falls and falling’ teams contribute to reducing the fall rate. However, few studies have been conducted in acute hospital settings. Therefore, in this study we summarized the characteristics and current status of hospitalized patients in terms of falls and falling incidents in our hospital from medical records and incident accident reports. 　　Among 230 patients, 291 falls and falling incidents were reported in 1 year; falls and falling accounted for 32.9％ of all incidents. In addition, the fall rate was 2.1 cases / 1,000 patients / day, average age was 77 years, and there was a higher tendency in men. Furthermore, falls and falling occurred on a median 13 days from hospitalization; in 124 cases (42.6％) within 10 days after hospitalization and in 60 cases (20.6％) from 10 days to 20 days. A similar tendency was seen in patients who were moved to the comprehensive community-based care ward. Therefore, we considered that the patient would require continuous attention after moving to that ward. Ultimately, falls and falling occurred in the late-night period (from midnight to 8 a.m.), and many were at the bedside (58.4％), and the purpose of movement was bowel motion (54.3％).

Objective: This study aimed to clarify outpatient nurses' awareness of their support for the decision-making of newly diagnosed cancer patients undergoing surgical therapy.Methods: Semi-structured interviews were conducted with eight outpatient nurses from two hospitals, and transcribed data were analyzed qualitatively.Results: The following four categories of outpatient nurses' awareness were extracted: "Difficult environment for supporting decision-making", "Identifying a patient in need of support", "Collaborating at the organizational level", and "Supporting the patient until a satisfying decision is made". Although the nurses recognized the need to support cancer patients' decision-making when undergoing surgical therapy, they were obliged to prioritize other duties and found it difficult to adequately provide the support needed. Although it was difficult, nurses tried to identify patients requiring support during their routine work, and to assist them until a satisfying decision was made by collaborating with colleagues at the organizational level.Conclusion: In order for outpatient nurses to more effectively support cancer patients' decision-making, it is necessary to allocate an adequate number of personnel, secure interview spaces, and provide training for nurses to improve their skills in decision-making support, in addition to implementing the necessary organizational changes.