The load applied to the neck-and-shoulder area of vineyard workers engaged in training and pruning is regarded as a cheif factor in developing the musculoskeletal disorders of the superior limbs. This study was designed to make some contribution toward developing a program to lighten the burden of vinedressers by investigating their workload and risk factors. For this purpose, vineyard workers were recruited. Operational analyses of posture measurements were performed by the use of video clips while they (=12) were at work. Another set of methods involved interviews and questionnaires (47 man-days) which asked about their physical tiredness and which part of the body was most tired. The questionnaire survey was conducted from May to June 2009. The results revealed that the backward bending of the neck, which was forcefully sustatined for a long time and repeated frequently (82% of the working hours), and the sustained elevation of the upper limbs (the left elbow joint raised above the shoulder:56% of the working hours) were a heavy load responsible for the systemic fatigue and the muscle fatigue in the neck-and-shoulder region. Especially, the tasks that went hard with the workers included leveling young vines up to the pergola, while holding the postures with cervical retrocession or raised upper limbs at the highest place in the vineyard, and treating gibberelin, the soulutions of which were a heavy load on the upper limbs. Pruning was the most difficult operation and took a lot of time, as the workers had not recovered from fatigue with the second round of gibberlin treatment. As the measures to be taken to reduce the work loads, we though it necessary to lower the level of workplace (use of improved vine training systems and better foodholds), utilize devices to support the head and upper limbs, and to use the limbs differently (alternate use of left and right arms and hands).

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  In Japan, there are many hospitals which do not have departments specializing in infectious diseases. Treatment of critical nosocomial infections such as candidemia is not sufficient and varies greatly from one institution to another. We reviewed the cases of candidemia in Saku Central Hospital from 2004 to 2008, and examined fungal species, clinical background, therapy, prognosis and the rate of treatment in accordance with the Infectious Diseases Society of America (IDSA) guidelines for candida infection. Blood culture revealed 43 cases diagnosed as candidemia. Candida albicans was the most common fungus. Antibiotics were administered to 84% of the patients and 79% had central venous catheters (CVC). The empirical antifungal administration included fosfluconazole and micafungin, but 23% of the patients did not receive any appropriate antifungal therapy. CVCs were removed from 23 of 34 patients, and 42% of the patients underwent ophthalmologic examination. Some of the patients (42%) were treated according to the IDSA guidelines, but most were not. The 28-day mortality rate was 33%. This study demonstrated that the strategy for treating candidemia in our hospital was insufficient, and also suggested that critical nosocomial infections cases were treated in adequately in many other regional hospitals in Japan. In conclusion, a well-organized and guideline-based therapeutic system is necessary in hospitals without the infectious diseases department.

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  This research was carried out to review the current state of thinga involving trainees (students and business workers) accepted by Anjo-Kosei Hospital and to clarify the role the Education Center in our hospital is expected to play in supporting trainees. The subjects were medical and non-medical students and business workers who signedup for our internship program and junior and senior high school students who paticipated in the hands-on training program at Anjo-Kosei Hospital between April 2006 and March 2009. A total of about 1,300 students and business workers had experienced the actual hands-on work each year. The number of medical students accepted was 289, 289, and 339 in 2006, 2007, and 2008, respectively. Besides, the number of non-medical students also increased from 847 to 1,045 in the period of three years. The business workers accepted came from 15 different types of occupation. It was found that junior and senior high school students were interested in the nursing-care field and this seemed to help them consider seriously their life as students and members of society, leading to the increased number of students who joined our program. In addition, unfortunately, two-fifths of the program were unfavorable for trainees because of poor management. The present research suggested that the Education Center take on a signification role in managing the internship and the hands-on training programs to accelerate the potential of students and business workers.

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  One patient was intervened by our palliative care team (PCT) to relieve neuropathic pain due to postoperative recurrence of rectal cancer. The dosage controlled-release oxycodone was increased, analgesic adjuvant drugs were changed and the administration of betamethasone were started. Furthermore, the number of times the patient took controlled-release oxycodone increased two to three times a day. These changes in medication resulted in relief of symptoms. Cetuximab therapy was given twice during the course. The other patient was intervened by the PCT for right upper limb pain and dyspnea due to postoperative recurrence of breast cancer. Morphine sulfate hydrate and analgesic adjuvant were additionally given. As pain increased three days after the administeration of transdermal fentanyl patches, the patches were changed every other day, instead of every three days. FEC100 therapy was given twice during the course. In the present two cases, the PCT was intervened with great zeal and rapid relief of symptoms resulted. In the meantime chemotherapy proceeded uneventfully. We thought that trust of the chief doctor in the PCT was most important for effective intervention.

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  A 16-year-old male with autism underwent a preanesthetic examination under intravenous sedation before dental surgery under general anesthesia, because he had resisted all treatment.
  To relieve the patient of physical and mental stress before he was brought to the operating room and venipuncture was performed for an intravenous drip, we administered midazolam to him orally.
  The patient was in the habit of having coffee every morning using the same cup. Such adherence is characteristics of autismtic individuals. We, therefore, put midazolam in his morning cup. He drank it with good grace. As a result, he fell into a sedated state. We were thereafter able to smoothly bring on general anesthesia.
  Our experience suggested that careful management allowing for disease characteristic could lead to the provision of hogh-quality medical services for mentally challenged patients.

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