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We report a rare case of gastric cancer presenting with a gastrocolic fistula during ramucirumab and paclitaxel combination therapy that was successfully managed with colonic stenting. A 75-year-old man was admitted to our hospital with the chief complaint of melena. Esophagogastroduodenoscopy revealed a large ulcerated tumor in the lower stomach, judged by laparoscopy as unresectable (sT4bN1M0). After four cycles of first-line chemotherapy with S-1 plus oxaliplatin, the patient showed disease progression, and second-line therapy with ramucirumab and paclitaxel was started. At the end of the third cycle, the patient had gastric antral stenosis, which necessitated the placement of a gastroduodenal stent. When the patient complained of diarrhea 10 days later, esophagogastroduodenoscopy revealed a fistula between the greater curvature of the stomach and the transverse colon. The fistula was covered by double colonic stenting, with a covered metal stent placed within an uncovered metal stent, after which leakage from the stomach to the colon stopped.
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Objective：To assess the risk for hyperkalemia caused by treatment with angiotensin Ⅱ Type 1 receptor blockers （ARB） in clinical practice with Japanese medical database.Design：A cohort study in patients treated with ARB alone and those treated with calcium channel blockers （CCB） alone as control.Methods：The Diagnosis Procedure Combination （DPC） database provided by Medical Data Vision Co., Ltd. was used to identify patients who received a diagnosis of hypertension (ICD-10 codes, I10 to I15) and were treated with ARB or CCB from April 2008 to June 2017. A logistic regression model was applied to estimate adjusted odds ratios （OR） and their 95％ confidence intervals （CI） in these patients. The outcome in the logistic model was hyperkalemia （serum potassium≧5.5 mEq/L） and the covariates were sex, age, renal insufficiency, hepatic insufficiency, and baseline serum potassium levels. And, subgroup analysis was also performed in patients with and without renal insufficiency.Results：The incidence of hyperkalemia （per 1000 person-years） with ARB was 39.4 and that with CCB was 32.6. And, median periods from the index date to the date of occurrence of hyperkalemia for both exposure and control groups were 36 days （Min-Max：12-85） and 51.5 days（Min-Max：8-88）respectively. However, treatment with ARB was not associated with occurrence of hyperkalemia （OR 1.26, 95％CI： 0.58-2.75). The risk for hyperkalemia among those with renal insufficiency was higher （OR 3.31, 95％CI： 1.39-7.88）and as baseline serum potassium increased, the risk increased as well （OR 9.20, 95％CI： 3.52-24.10). And, the subgroup analysis also showed that rare occurrence of hyperkalemia by ARB and elevation risk for hyperkalemia by baseline serum potassium.Conclusion：The clinical data showed rare occurrence of hyperkalemia caused by ARB, indicating that renal insufficiency and baseline serum potassium levels affected the onset of the disease in clinical practice. Previous studies also reported the effects of renal insufficiency and other factors on the onset of hyperkalemia. ARB should be prescribed carefully in patients with these factors, as is conventionally done.
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We established the Technical Aids Support Office in our hospital to promote the introduction of and technical advice about assistive technology so as to enhance the quality of care and the functioning of patients and ensure staff safety. In this paper, we introduce two complicated cases that needed individual support. Case 1: A patient with amyotrophic lateral sclerosis. The amount of assistance required had gradually increased, but the patient still hoped to use a portable toilet. Because he could barely stand up, the height of the toilet needed adjustment. An elevated seat decreased the amount of assistance required. However, raising the bottom of the portable toilet turned out to be a challenge. Case 2: Multiple limb amputee. The patient and the caregiver experienced pain and distress during transfer between bed and chair. We tried using a lift assist device, but it the hardness of the sling worsened pain at the stump. A cushion with a sliding seat was then placed between the sling and the patient to reduce friction. The shape and hardness of cushion is a future challenge to solve. Timely individual support at each stage in their care for individual patients is indispensable for the provision of technical aid support.
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Interprofessional education in the workplace is necessary for effective interprofessional collaboration. Various multi-professional training programs are conducted in hospitals, but their general features are not clear. In this study, we carried out a survey of staff in S Hospital to reveal the types of multi-professional training undertaken and participation rates. The study involved interviews held with 12 staff in the hospital and a questionnaire survey of all hospital staff. From the interview, we extracted 3 types of training (on-the-job training, off-thejob training, and informal activities) and 4 core skills to be learned and/or taught. The questionnaire survey (N = 1325, response rate 56.7%) revealed the main participation rates in training as care team activities 71.2%, freshman training 65.8%, other training in the institute 60.0%, training outside the institute 47.7%, and case discussion 42.9%. Around 90% of hospital staff participated in 1 or more of these trainings. Comparison for each attribute (Chi-square test and residual analysis) revealed that participation rates were as follows: (1) higher in freshman training and lower in the other types of training, the shorter the career of the participant (p < .01); (2) higher in social workers for all trainings, higher in nurses and care workers, healthcare technicians, and therapists for freshman training, care team activities, and training in the institute, and higher in physicians at case discussion and training in the institute (p < .01); (3) higher in chronic care units for all trainings except freshman training (p < .01, p < .05); and (4) lower in non-managerial staff for all trainings except freshman training (p < .01). Thus, multi-professional training can be used as a resource for interprofessional practice and education by determining the general features of these programs and setting common goals for 2 or more trainings. A future study to reveal the characteristics of each training, including informal activities, and the associations between them is warranted.
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<b>Object: </b>A multicenter survey was conducted to investigate the status of use of supplements and related problems in patients with diabetes mellitus.<br><b>Methods: </b>A questionnaire was mailed to institutions where members of the Drug Information Section, Tokyo Hospital Pharmacists Association, worked, and hospitalized patients with diabetes mellitus were surveyed with a questionnaire.<br><b>Results: </b>The response rate of the questionnaire was 85%, and 22 patients reported taking supplements. The most common motivation to purchase supplements was a recommendation from an acquaintance, followed by a recommendation from a family member and TV. Only 9.1% of the patients consulted healthcare professionals when purchasing supplements. The patients who did not follow the dosage and administration instructions and those who were not aware of precautions regarding proper use accounted for 31.8% and 63.6%, respectively. The proportion of patients who did not inform their physicians about the use of supplements was 65.2%, and 4.5% reported some health damage (rash).<br><b>Conclusion: </b>Our results revealed that supplements were used without careful consideration and were not administered properly, suggesting that scientific evaluation of efficacy and safety was warranted in future studies. It is important for pharmacists to actively collect information on patient use of supplements and share the information within the medical team.
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To provide appropriate healthcare services to all patients, strong interprofessional partnerships are essential. We have developed a voluntary community-based interprofessional education (IPE) program for medical students and other healthcare students. In this program, students from different healthcare fields conduct fieldwork together in small groups. The purpose of this study was to determine what participants learned through the IPE program.<BR>1) Five researchers with different healthcare backgrounds analyzed all (63) participants' postprogram reports (collected since 2002) and extracted and categorized items describing what the participants had learned.<BR>2) The categories of items learned included the roles of healthcare professionals, cooperation among healthcare professionals, the meaning of “community medicine”, the difficulty and the importance of communication, and a sense of fellowship with participants of other backgrounds.<BR>3) These items indicate our IPE program helps students learn about interprofessional cooperation by observing actual examples of cooperation in the community and by working with students from different healthcare fields.