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Background: Physician attire influences perceptions of care. This study was conducted to evaluate the impact of physician attire on perceptions of care by patients and families in a Japanese palliative care unit. Methods: From November 2018 to February 2020, patients and family members admitted to the Palliative Care Unit at Jichi Medical University Hospital were recruited and completed a survey consisting of 4 demographic questions and 15 questions regarding perceptions of care. A 7-point Likert scale (1 = strongly agree, 4 = neutral, 7 = strongly disagree) was used to judge attire (name tag, long sleeve white coat, short sleeve white coat, scrubs, scrub color, jeans, sneakers) addressing patient and overall impact on perception of care. Results: Of 203 patients admitted, 79 were enrolled. Surveys were received from 23 patients and 52 family members. Patients and families want physicians to wear name tags (median, interquartile range) (2, 1-2) and white coats (3, 2-4). Patients want to be addressed by surnames (2, 1.5-4). Patients and family members have neutral opinions about short sleeve white coats (4, 4-4) and scrubs (4, 4-4). Jeans were not liked (4, 4-6) while sneakers are acceptable (3, 2-4). The impact of attire on perceptions of care is significantly (p = .04) greater for patients (3, 2-4) than family members (4, 3-4). Conclusion: Patients and family members prefer their physicians to wear name tags and white coats and address patients by surnames. Physician attire has a significantly greater impact on perceptions of care for patients than family members in a palliative care unit.

Background Trust is a key factor in achieving a good death. However, few studies have focused on factors that help terminal cancer patients to establish trusting relationships with their palliative care doctors. We therefore designed this exploratory qualitative study to identify factors related to terminal cancer patients’ trust in their doctors. Methods We conducted a semi-structured interview with 18 participants for data collection, and we opted to use the grounded theory approach in our analysis of the data. Results Our data revealed seven factors: 1) caring attitude, 2) symptom management, 3) courteous and specific explanations, 4) long-term involvement in the patient’s care, 5) being faced with inevitable death, 6) good impression of the institution, and 7) referral by a trusted doctor. These factors are categorized under three main themes: [1] palliative care doctors, [2] terminal cancer patients, and [3] institutional and professional reputation. Three of these factors are uniquely characteristic of palliative care: symptom management, being faced with inevitable death, and referral by a trusted doctor. Conclusions In this study, we clarified the seven factors with a qualitative study evaluating the perspective of bereaved family caregivers on aspects that related to their corresponding patient`s trust in palliative care physicians. In future, more quantitative research is needed to assess the validity of the factors identified here and to understand how these factors are associated with quality of death.

This report presents a case of nephrotic syndrome and renal failure that developed in a 53-year-old female with metastatic breast carcinoma. She was diagnosed to have osteolytic bone metastases 5 years prior to admission, and had been administered pamidronate with a total dose of approximately 6800 mg. A renal biopsy revealed tubulointerstitial damage and marked wrinkling and retraction of the glomerular basement membrane with hypertrophy and hyperplasia of the epithelial cells, compatible with the collapsing form of focal segmental glomerulosclerosis (FSGS). Despite the discontinuation of pamidronate after admission, her renal function gradually decreased. She was finally managed with continuous palliative care for advanced malignancy through a shared effort, and died 96 days after undergoing the renal biopsy. Although the clinical impact of the pamidronate-associated kidney injury on the longitudinal changes in renal function remains to be delineated, it is therefore reasonable to consider that the collapsing FSGS associated with tubulointerstitial damage may have resulted in the irreversible renal injuries that were observed in the current case. Further studies and accumulated experience with renal biopsy are required to better determine the relationship between pathological alterations and prognostic characteristics among patients with pamidronate-associated renal impairments.

It is very important, but not clear, how physicians differ from nephrologists in treatment of renal insufficiency.To demonstrate differences in decision-making in treatment of renal insufficiency between physicians and nephrologists.Postal questionnaire.All physicians were graduates from one medical school and certified by the Japanese Society of Internal Medicine. Nephrologists were certified by the Society and the Japanese Society of Nephrology.Questionnaires were sent to 1,395 physicians and 385 nephrologists, including audit of serum creatinine concentration that would indicate referral to nephrologist, audit of continuation of angiotensin converting enzyme inhibitor (ACEI) for a case of renal insufficiency and mild hyperkalemia due to ACEI. Outputs were proportion that selected "serum creatinine 177 micromol/l (2.0 mg/dl) and over" as a referral point to the nephrologist, and proportion that chose "suspend ACEI" for a case of renal insufficiency and mild hyperkalemia due to ACEI.Six hundred and fourteen physicians replied (44%), and 111 certified in internal medicine were extracted from them. One hundred and eighty-six certified nephrologists replied (47%), and 114 certified in internal medicine were extracted. The proportion that chose "177 micromol/l" as a referral point to the nephrologist was 20% for physicians and 61% for nephrologists (P0.0001). An additional 17% of nephrologists recommended creatinine concentration below 177 micromol/l, whereas no such opinion was found among physicians. The proportion that chose "suspend ACEI" was 45% for physicians and 16% for nephrologists (P0.0001).There is significant difference between decisions made by physicians and nephrologists regarding treatment for patients with serum creatinine concentration of 177 micromol/l.

ネフローゼ症候群を呈し, 先天性片腎無形成を伴ったKlippel-Feil症候群と診断された患者が, 慢性腎不全に進行し, CAPD導入となったので報告する. 症例は, 42歳女性. 9年前顔面浮腫を呈し, ネフローゼ症候群と診断. 精査にて片腎であり, 短頸, 頸椎癒合, 側彎を認め, Klippel-Feil症候群と診断. 腎生検は行われなかった. 3度妊娠するも腎機能障害のため2度は, 人工中絶, 1度だけ中絶を勧められるも出産した. その後外来通院せず平成7年12月呼吸困難にて近医入院, ダブルルーメンカテーテルにて血液透析施行. 当院紹介されるも動脈奇形にて内シャント造設できず, negative selectionにて平成8年1月CAPD導入となった. Klippel-Feil症候群にて腎不全を起こした報告は稀であり, ここに報告した.

The alpha-subunit of the amiloride-sensitive epithelial Na+ channel (alpha ENaC) is critical in forming an ion conductive pore in the membrane. We have identified the wild-type and three splice variants of the human alpha ENaC (h alpha ENaC) from the human lung cell line H441, using RT-PCR. These splice variants contain various structures in the extracellular domain, resulting in premature truncation (h alpha ENaCx), 19-amino acid deletion (h alpha ENaC-19), and 22-amino acid insertion (h alpha ENaC + 22). Wild-type h alpha ENaC and splice variants were functionally characterized in Xenopus oocytes by coexpression with hENaC beta- and gamma-subunits. Unlike wild-type h alpha ENaC, undetectable or substantially reduced amiloride-sensitive currents were observed in oocytes expressing these splice variants. Wild-type h alpha ENaC was the most abundantly expressed h alpha ENaC mRNA species in all tissues in which its expression was detected. These findings indicate that the extracellular domain is important to generate structural and functional diversity of h alpha ENaC and that alternative splicing may play a role in regulating hENaC activity.

Background: There is currently no consensus syllabus of palliative medicine for undergraduate medical education in Japan, although the Cancer Control Act proposed in 2007 covers the dissemination of palliative care. Aim: To develop a nationwide consensus syllabus of palliative medicine for undergraduate medical education in Japan using a modified Delphi method. Design: We adopted the following three-step method: (1) a workshop to produce the draft syllabus; (2) a survey-based provisional syllabus; (3) Delphi rounds and a panel meeting (modified Delphi method) to produce the working syllabus. Educators in charge of palliative medicine from 63% of the medical schools in Japan collaborated to develop a survey-based provisional syllabus before the Delphi rounds. A panel of 32 people was then formed for the modified Delphi rounds comprising 28 educators and experts in palliative medicine, one cancer survivor, one bereaved family member, and two medical students. Results: The final consensus syllabus consists of 115 learning objectives across seven sections as follows: basic principles; disease process and comprehensive assessment; symptom management; psychosocial care; cultural, religious, and spiritual issues; ethical issues; and legal frameworks. Learning objectives were categorized as essential or desirable (essential: 66; desirable: 49). Conclusions: A consensus syllabus of palliative medicine for undergraduate medical education was developed using a clear and innovative methodology. The final consensus syllabus will be made available for further dissemination of palliative care education throughout the country.

Facing a terminal illness is stressful and difficult for patients and their families. Compared with routine medical care, palliative care often requires intense individual attention. Art therapy is sometimes useful in such cases. In this comment piece I discuss the use of personalized poems. In my work with patients who have advanced malignancy, I have found poetry to be a valuable tool in caring for patients and families.

A case of human T-cell lymphotrophic virus type I (HTLV-I)-associated myelopathy (HAM) occurring in a 62-year-old Japanese male with a history of hemodialysis and repeated blood transfusions due to chronic renal failure (CRF) is reported. The patient was a lifelong resident of Chiba Prefecture, a nonendemic area for HTLV-I infections. The clinical course was characterized by abrupt onset and rapid progression of neurological signs and symptoms, which appeared to have responded quite well to prednisolone. Although patients with a history of CRF, hemodialysis, and transfusion of blood units which were not screened for anti-HTLV-I antibodies appear to belong to the high risk group for HTLV-1 infections and subsequent development of HAM, reports on such cases have been scanty. Only 3 cases have been reported to date. It appears quite possible that many patients with CRF and HAM remain misdiagnosed.

We report on the case of a 45 year old male with focal segmental glomerulosclerosis (FSGS) in whom steroid-resistant proteinuria was reduced rapidly by plasma exchange. In 1994, he was admitted to our hospital because of massive proteinuria of several years' duration. Renal biopsy confirmed the diagnosis of FSGS. Proteinuria was suppressed partially with the use of dipyridamole. Though oral prednisolone (PSL, 30 mg/day) was effective initially, relapse occurred during PSL tapering. Doses of PSL up to 30 mg/day or additional mizoribine were ineffective. The patient was readmitted for a trial of plasma exchange in April 2000. Four sessions of plasma exchange with albumin replacement over 2 weeks immediately reduced the proteinuria from 3.2 g/day to 0.6 g/day without any change in medication. After discharge, proteinuria remained suppressed for more than 6 months despite a reduction of PSL dose to 15 mg. The rapid and long lasting effect of plasma exchange in the present case argues for the role of a putative circulatory factor in the pathogenesis of proteinuria in FSGS.

Background Palliative care education for undergraduate medical students has not been well established in Japan. A foundation supported our university to have a department of palliative care medicine for undergraduate palliative education for three years. Fortunately, a nationwide consensus syllabus of palliative medicine for undergraduate medical education had been developed. Objectives To reflect the development of curriculum of palliative care for undergraduate. Materials & Methods Materials; (1) source of the syllabus, (2) source of teaching materials, (3) teaching staffs and supporters. Methods; evaluation by (1) development of the curriculum, (2) analysis of the budget, (3) analysis of the access of our website with Google analysis®. Results (1) Development of the curriculum; Number of the annual classes of palliative care increased from 13, 18, 22, respectively. (2) Analysis of the budget; 66.4% of annual expenditure was personnel expenses, 10.0% for administrative expenses, 6.0% for supplies expenses, 4.1% for travel expenses, 3.9 % for appliances, 9.6% for others. (3) Effect of disclosure of educational resources; the daily access to our website was significantly concentrated just before the national medical practitioners qualifying examination in Japan compared with that after the exam (p Conclusions Experienced palliative staffs, total support by the university, moderate financial resource and developed syllabus enabled systematized palliative education for undergraduate medical students. It might propagate related to the national medical practitioners qualifying examination.