Purpose: The purpose of this study is to clarify the factors related to the content of consultation in the cancer nursing outpatient department of Gunma University Hospital. Method: A retrospective survey was conducted with 1084 cases, excluding the unknown cases, from 1308 consultations in FY2019. Survey items included age, gender, consulter, number of uses, treatment status, consultation content, etc. We conducted χ2 tests, and binomial logistic regression analysis between the content of the consultation and the attributes of the user. Results: The treatment-related content was associated with the following factors: 70s or older, family/relatives only, presence of recurrence/metastasis, first use, pre-treatment, urinary organs, uterine/ovary, and unknown primary. The body-related content was associated with the following factors: under treatment, post-treatment, no recurrence/metastasis, and digestive organs. The mental health-related content was associated with 30s or younger, 40s–60s, patient only, and second time or more. The social aspects-related content was associated with the following factors: patient only, family/relatives only, no recurrence/metastasis, and breast. Conclusion: The results reveal that associated factors differ by consultation content. These findings can be used to prepare for consultation based on the relevant associated factors.

Background/Aims: Herbal medicine is an important complementary therapy for functional dyspepsia (FD). However, its effect against gastric hypersensitivity in patients with FD has rarely been evaluated. Yokukansan (YKS), a traditional Japanese herbal medicine, is effective against neuropathic and inflammatory pain. This study aims to use a maternal separation (MS) stress-induced FD model to investigate the effects of YKS against gastric hypersensitivity, gastric motility, and duodenal micro-inflammation. Methods: The MS stress model was established by separating newborn Sprague-Dawley rats from their mothers for 2 hours a day from postnatal days 1 to 10. At the age of 7-8 weeks, the rats were treated with YKS at a dose of 5 mL/kg (1 g/kg) for 7 consecutive days. AfterYKS treatment, electromyographic activity in the acromiotrapezius muscle by gastric distention and the gastric-emptying rate were assessed. Immunohistochemical analysis of eosinophils in the duodenum and phosphorylated extracellular signal-regulated kinase(p-ERK) 1/2 in the spinal cord was performed. Results: YKS treatment suppressed MS stress-induced gastric hypersensitivity and decreased the elevated levels of p-ERK1/2 in the spinal cord.In the gastroduodenal tract, YKS inhibited eosinophil-associated micro-inflammation but did not improve gastric dysmotility. Conclusions YKS treatment improved gastric hypersensitivity by alleviating eosinophil-associated micro-inflammation in the gastroduodenal tract.This treatment may be considered an effective therapeutic option for epigastric pain and micro-inflammation in patients with FD.

Lenvatinib hasapplicationsin thyroid and hepatocellular carcinomas. When lenvatinib wasapproved for hepatocellular carcinoma in Japan, the manufacturer noted an increase of 5% in the incidence of side effects than those observed in thyroid cancer, based on the clinical-trial data. The monitoring of side effectsisimportant during chemotherapy. It isdifficult to confirm all the side effects within a single practice, and it is important to consider the incidence and severity of side effects before prescribing a particular treatment regimen. An antineoplastic agent is often used for different diseases, and it may be difficult to confirm a specific side effect. Because clinical conditions vary among different diseases, it is likely that the onset of side effects also differs. We investigated the difference between the onset of side effects in thyroid and hepatocellular carcinomas using the Japanese Adverse Drug Event Report database. The main side effects reported for thyroid cancer included bleeding, hypertension, cardiac disorders, myelosuppression,acute cholecystitis, delayed wound healing, infection, gastrointestinal perforation, fistula formation, and pneumothorax. In addition,patients with hepatocellular carcinoma experienced liver damage and hepatic encephalopathy. A significant strong correlation was observed between the drug dose and number of reports of the varied side effects. We compared the side effects in patients with thyroid cancer to those with hepatocellular carcinoma; although the same drug was used, there was varied expression of the side effects. Thisneedsto be taken into account when determining which drugsare to be used for the treatment of a particular cancer type.

Objective: This study aimed to clarify the circumstances and challenges in home care-oriented hospital nurse training on the basis of results of hospital nurse self-evaluations of nursing activities implemented in preparation for home care.

Methods: Group interviews were conducted with 13 nurses at 9 different hospitals, and the results were qualitatively and inductively analyzed.

Results and Discussion: Six categories for actual nursing activities implemented in preparation for home care were extracted. These categories were "I leave home care to other medical professionals," "No form of inter-hospital cooperation has been established," "There is disparity in cooperation with home-visiting nurses," "Social resources are not being used due to a lack of knowledge," "Able to develop a perspective of home care through workshop participation, years of experience, and interest," and "Competency is lacking despite knowledge of home care." Home care was apparently not being utilized by hospital nurses due to a lack of knowledge of social resources and a lack of interdisciplinary cooperation.

Conclusions: Challenges in nurse training implemented in preparation for home care included compensating for the lack of practical knowledge of social resources and devising a duty system and inter-facility exchanges to allow nurses to build experience in other areas and departments. The results of this study suggested the need for organizational training initiatives and for improvement of the quality of individuals in order to put acquired knowledge into practice.

BACKGROUND/AIMS: Few studies are available that have investigated the risk factors for overlapping irritable bowel syndrome (IBS)-like symptoms in patients with inactive inflammatory bowel disease (IBD). The present study has 3 objectives: (1) to assess the prevalence of IBS-like symptoms in Japanese patients with inactive IBD using Rome III criteria, (2) to examine the relationship of IBS-like symptoms to health related quality of life (HR-QOL), and (3) to investigate associations for developing IBS-like symptoms in patients with inactive IBD. METHODS: IBS-like symptoms were evaluated using the Rome III questionnaire for functional gastrointestinal disorders. HR-QOL and hospital anxiety and depression scale were evaluated. RESULTS: IBS-like symptoms were found in 17.5% (7/40) of patients with inactive ulcerative colitis, 27.1% (29/107) of patients with inactive Crohn’s disease (CD), and 5.3% (23/438) of healthy control subjects. The QOL level was significantly lower and anxiety score was significantly higher in inactive CD patients with IBS-like symptoms than in those without such symptoms (P = 0.003, P = 0.009). Use of anti-anxiety drugs was associated with the presence of IBS symptoms (P = 0.045). HR-QOL score was lower and anxiety score was higher in patients with inactive ulcerative colitis, but the difference was not statistically significant. CONCLUSIONS: The prevalence of IBS-like symptoms in inactive IBD patients was significantly higher than in healthy controls. Inactive CD patients with IBS-like symptoms has low QOL and anxiety; suggesting that anxiety may be associated with symptom development in such patients.
Anti-Anxiety Agents ; Anxiety ; Asian Continental Ancestry Group* ; Colitis, Ulcerative ; Depression ; Gastrointestinal Diseases ; Humans ; Inflammatory Bowel Diseases* ; Irritable Bowel Syndrome ; Prevalence* ; Quality of Life ; Risk Factors

Introduction : We initiated an ambulatory care training program at five community hospitals in Nagasaki, including hospitals on remote islands, for the residents of Nagasaki University Hospital. We examined the educational effect of the ambulatory care training program in meeting the achievement targets for clinical training.
Methods : The study included all residents (n=49) working in Nagasaki University Hospital in 2012. Following completion of the ambulatory care training program, the residents answered a questionnaire on the number of patients and their symptoms, inaddition to a self-assessment, and assessment by their supervisor.
Results : The mean number of patients seen was 3.29 persons / training session. The number of symptoms to be encountered, which are established by Ministry of Health, Labour and Welfare, was positively correlated with the total number of patients seen. Although residents initially had a low rating of self-assessment on diagnosis or treatment, this rating tended to increase with time. The gap in levels on assessment of history taking, diagnosis, or treatment by residents versus those by the supervisors reduced with time in the program.
Conclusion : Our ambulatory care training program is an effective program for meeting the achievement targets in clinical training for residents.

Objectives
  More than half of those living in developing countries do not have piped water in their homes. Although handwashing is effective for the elimination of microbes from the surface of the palms, thereby preventing the transmission of infectious diseases, the effect of using poor-quality water for handwashing is unclear. This study measured the water quality and the bacteria count on the hands of preschool children in Kathmandu, Nepal.
Methods
  Sixty-two children were asked to follow their normal handwashing technique, and the counts of 3 microbial bacteria—viable bacteria, Escherichia coli, and total coliforms—were measured in the water source and on the children’s palms. Microbial samples from the children’s palms were collected before and after handwashing. The Wilcoxon signed-rank test was used to compare the number of bacteria on the palms before and after handwashing.
Results
  The children washed their hands with a low volume of stored water without soap. Viable bacteria, E. coli, and total coliforms were detected in the water source. The number of viable bacteria and total coliforms on the palms increased after handwashing. In contrast, the numbers of E. coli colonies did not change after handwashing.
Conclusion
  Handwashing with poor quality of water did not have effect on removal of bacteria from hands. In areas with limited water sources, intervention for handwashing requires strategies for not only promoting hygiene behaviors also water storage management.

Kampo treatment is frequently effective for patients with acne vulgaris who are unresponsive to standard treatment with western medicine. We report two cases of acne vulgaris successfully treated with tokikenchuto. In the first case, a 32-year-old woman complained of mild acne, loose stool and menstrual pain. Her abdomen was soft and a pulsation above the navel was noted. These symptoms were considerably improved after taking tokikenchuto. In the second case, a 26-year-old woman presented with moderate acne, loose stool and menstrual pain with excessive strain of the abdominal muscles and objective tenderness on the sides of the abdomen. Kamishoyosan and tokishakuyakusan were first prescribed, although these caused bowel disturbances, and eventually tokikenchuto was prescribed, which improved the acne. We suggest tokikenchuto is effective for patients with mild to moderate acne who have bowel disturbance with soft abdomen or excessive strain of the abdominal muscles, which are considered indicators of gastrointestinal weakness. In addition, yokuinin has a synergistic effect in the treatment of acne.

We investigated original texts for yokukansan, a familiar Kampo formula, focusing on the classical literature Xue-shi yi-an (薛氏医案) . Yokukansan was described in the Bao-ying jin-jing-lu (保嬰金鏡録) written by Xue ji (薛己) in 1550, the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551,the Bao-ying cuo-yao (保嬰撮要) by Xue kai (薛鎧) in 1556, and the Xiao-er dou-zhen fang-lun (小児痘疹方論) in 1550. The phrase “one's own work” was used in “Bao-ying jin-jing-lu (保嬰金鏡録)” and in the Xiao-er dou-zhen fang-lun (小児痘疹方論) by Chen wen-zhong (陳文仲). However, there was no mention of “one's own work” in the same title, the Xiao-er dou-zhen fang-lun (小児痘疹方論), as summarized by Xiong zong-li (熊宗立).
Yokukansan was found only in the Xiao-er yao-zheng zhi-jue (小児薬証直訣) revised by Xue ji (薛己) in 1551, but not in the other copies of the same text. Therefore, it seems likely that yokukansan was created by Xue ji (薛己) himself.
Yokukansan was previously thought to have originated with the Bao-ying cuo-yao (保嬰撮要). However, based on use of the phrase “one's own work” in the classical literature, it appears that the original text for yokukansan should be the Bao-ying jin-jing-lu (保嬰金鏡録). Therefore, yokukansan seems to have been made by Xue ji (薛己), and not Xue kai (薛鎧), who was his father.