This study evaluated the effect of repeated inhaler technique assessment as an educational intervention by pharmacists on inhaler technique and inhalation therapy in outpatients with chronic obstructive pulmonary disease （COPD） and bronchial asthma. Inhaler technique assessments, adherence and subjective symptom questionnaires, peak expiratory flow rate （PEF）, and peripheral oxygen saturation （SpO₂） values were evaluated four times for each outpatient at the pharmacy. A total of 99 patients （24 with COPD; 75 with bronchial asthma） were analyzed. The baseline scores of some inhaler techniques, including “inhalation” procedure, were significantly lower in patients with COPD than those in patients with asthma. From the second intervention onward, in both diseases, the proportion of patients with poor inhaler technique in most procedures decreased, but in some procedures, this decrease was limited, suggesting the influence of age （70 years or older）. The baseline inhaler technique scores of patients using a dry powder inhaler tended to be higher than those of patients using other devices. However, the difference between the devices was reduced during the repeated interventions. With pharmacist interventions, the number of patients with poor compliance decreased for COPD; however, it was not observed for asthma, suggesting that patient education on pathology or drug treatment is also necessary for patients with asthma. The subjective symptoms in both diseases improved, and the PEF level significantly increased with intervention. The SpO₂ levels significantly increased only for asthma. This study showed that repeated inhaler technique assessment by pharmacists can bring significant improvement in patients’ inhalation therapy without changing any drugs. However, the degree of improvement may vary depending on the disease, age, and inhaler device. Additionally, further individualized education on the disease or inhalation procedure may be necessary.

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This study aimed to examine the teaching activity-related difficulties encountered by and support needed by young faculty members teaching psychiatric mental health nursing in university nursing programs and identify the aspects of support that would improve their practical teaching skills. Semistructured interviews were conducted with 11 young faculty members （four of whom were in their first year of being a part of the faculty）, and a qualitative analysis was performed on interview transcripts with focus on themes. The analysis identified seven categories of difficulties faced during teaching activities, which represented fundamental difficulties faced by university faculty members in nursing, such as understanding on university education in nursing; basic abilities to provide student support; specificity of the therapeutic environment, ethical dilemmas, and role of psychiatric mental health nursing; and difficulties experienced through actual teaching in psychiatric mental health nursing, such as abilities in expression as a faculty member teaching psychiatric mental health nursing and strength to continue tackling the material, which is difficult to understand. Furthermore, support required was expressed in four categories, comprising items related to dealing with the fundamental difficulties faced as a university faculty member of nursing, including initiation to educational methods in the university, and items that correspond to the central goals of young faculty members as teachers of psychiatric mental health nursing, such as the existence of mentors and role models, settings to become acquainted with peers, and accurate communication within the field. Thus, these findings suggested that young faculty members needed support in verbalizing their own goals in psychiatric mental health nursing education and expressing their determination in their specialty.

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Dermatomyositis （DM） is an autoimmune disease that is characterized by skin eruptions, which causes inflammation-induced weakness of the proximal limbs, trunk, and neck muscles. Sometimes, perioperative stress-induced shock and postoperative infection develop in patients due to the need for long-term corticosteroid therapy. We report a case of a 30-year-old male patient with DM with skeletal mandibular prognathism who underwent orthognathic surgery. The patient visited the Department of Orthodontics at our hospital with a complaint of anterior crossbite. Subsequently, he was referred to an oral and maxillofacial surgeon for orthognathic surgery. He was first diagnosed with DM at the age of 3 years and had been treated with corticosteroids and immunosuppressants for a long time. At this presentation, the DM was stable with a maintenance dose of 3mg prednisolone per day, but steroid-induced osteoporosis was present. No complications were observed when sagittal splitting ramus osteotomy was performed under general anesthesia. Additionally, steroid cover was given during the perioperative period. He has been followed up for 2 years after orthognathic surgery, and no abnormal occlusion or local infection has been observed.

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Duloxetine, an analgesic drug approved for clinical use, reduces the central sensitization to relieve chronic pain. Several clinical trials proved the efficacy and safety of duloxetine monotherapy, and we demonstrated that additional duloxetine administration showed favorable efficacy and safety in our previous study. This study aimed to investigate the characteristics of patients who can obtain a more satisfactory effect of duloxetine. The central sensitization of each patient was evaluated using the central sensitization inventory （CSI）. The efficacy of additional duloxetine administration, which was evaluated by changes in low back pain visual analog scale （VAS） scores, lower limb pain VAS scores, and 36-item Short-Form Health Survey version 2 scores from baseline, was compared between patients with CSI scores of ›34 and those with CSI scores of‹34. In this study, 14 patients were observed for more than 1 month after duloxetine administration. Out of the 14 patients, 7 patients showed high CSI scores （›34）, and the mean low back pain VAS score was higher in patients with high CSI scores than in those with low CSI scores （‹34）, which were insignificant changes. After 1month of duloxetine administration, the changes in the mean low back pain VAS score were −19±4.8mm in patients with high CSI scores and −12±7.2mm in patients with low CSI scores. The “role physical” scores increased by 35.3±5.2 in patients with high CSI scores and 7.0±5.3 in patients with low CSI scores, and the “role emotional” scores increased by 43.6±5.8 in patients with high CSI scores and 9.8±3.6 in patients with low CSI scores. The improvement in patients with high CSI scores was greater than that in patients with low CSI scores with significant changes （p‹0.01, Wilcoxon t-test）. Therefore, duloxetine administration should be considered for patients with central sensitization to improve pain-related disabilities.

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Several medical institutions fumbled while establishing countermeasures to ensure the safety of patients and medical professionals during the coronavirus disease 2019 （COVID-19） pandemic. Herein, we introduce the COVID-19 infection countermeasures practiced at the Fujigaoka Hospital emergency room （ER）. Triaging, personal protection, and infrastructure improvement are the main countermeasures practiced. Sometimes, the data obtained from emergency service, patients, and family members may be inadequate, and even asymptomatic patients may have COVID-19. Therefore, nurses initiated triaging in June 2020 for all emergency patients. This enabled the stratification of examination order, examination location, and COVID-19 risk. In July 2020, regardless of the COVID-19 pandemic, all ER staff at our hospital mandatorily started using N95 masks and eyeguards as standard personal protective equipments because aerosol-generating procedures, such as performing suction, may be required unexpectedly. Earlier, there was only one examination room for negative-pressure ventilation. Therefore, all examination booths were converted into ventilated private rooms with a window, a bed, and a ventilation fan in each booth. An airborne isolation unit was installed in examination rooms without a window. In December 2020, two automatic negative-pressure boosts were installed in the recovery room for infection control. Patients with COVID-19 could be examined at all booths. Although all emergency patients were suspected to have COVID-19, changes in the ER improved medical care efficiency. No COVID-19 infections occurred among the nurses and critical care physicians working in ERs by practicing these infection control measures. We hope that the infection control protocol practiced at the Showa University Fujigaoka Hospital ER will be helpful for other institutions.

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