Rehabilitation in highly acute care hospitals is an effort to prepare patients for a smooth transition in to recovery-phase hospitals, living-phase hospitals, and clinics. It helps to safely manage critically ill patients to promote their early release from the hospital and transfer of patients for efficient use of medical resources. The rehabilitation department of Showa University Hospital can be considered adequate in terms of promptness; however, there remains a scope for improvement in the number of interventions per patient. Improvement is required to ensure adequate staffing. The remote intensive care unit support center Showa eConnect and various other devices are available for safe and efficient early weaning, and rehabilitation that leads to recovery and living phases is being developed with an eye on post-intensive care syndrome. During the coronavirus disease 2019 pandemic, a specialized rehabilitation team was formed to provide direct therapeutic intervention while protecting the safety of staff and hospitalized patients. To demonstrate the effectiveness of perioperative rehabilitation, all patients with esophageal cancer were managed right from the time of admission for preoperative chemotherapy, and achieved a shorter hospital stay after surgery through a program that aimed at postoperative recovery and early discharge. Although this program cannot be easily applied to all surgical procedures, it is expected to be highly effective if implemented efficiently in cooperation with multiple departments. Rehabilitation in highly acute care hospitals is constantly changing and evolving. Therefore, going forward, it is expected to expand as an offensive rehabilitation that eventually reaches the area of preventive medicine.

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With the increasing survival rates of critically ill patients, patients with long-term sequelae post-discharge from the intensive care unit （ICU） and their living conditions have become apparent. Physical and cognitive impairments and psychological disturbances persisting after ICU discharge are barriers to reintegration and long-term prognosis of ICU survivors. Under these circumstances, the “Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit （PAD Guidelines）” were revised to address patient-centered management of pain, restlessness, and delirium, including patient distress and stress during the ICU treatment, as well as early mobilization and rehabilitation in the ICU. The PAD guidelines were subsequently revised into PADIS guidelines with additional issues related to immobility and sleep disruption, and advances in analgesia and sedation management have dramatically increased the use of early rehabilitation in the ICU, resulting in shorter ventilation periods and improved activities of daily living. Physical therapists play a diverse role in the ICU. They focus on several tasks, including: 1） improving physical function through exercise therapy, early mobilization, and complication prevention, 2） planning and coordinating specific exercise programs, 3） assessing patients, 4） monitoring exercise sessions, and 5） providing feedback on their effectiveness. To realize life plans that have been left unfulfilled after recovering from a serious illness, it is important to carefully listen to how patients live their lives, support their recovery of physical functions, and implement countermeasures against various complications in cooperation with multiple professions, which will lead to a brighter long-term prognosis post-discharge. With the continuously increasing elderly population, established treatment strategies for post-ICU syndrome have not yet been identified. In the future, detailed physical therapy tailored based on the characteristics of the elderly people and focusing on long-term prognosis will be required.

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The Ministry of Health, Labor, and Welfare is promoting the establishment of a comprehensive community support and service delivery system （community-based integrated care systems） in which occupational therapists play an important role. The community support system includes medical care, and Showa University Hospital is a medical institution and part of the system that plays a vital role in the community. This study discusses the practice of occupational therapists targeting the acute phase of care, a unique program at Showa University. Occupational therapy is a treatment, guidance, and assistance centered on “occupation” or activities of daily living in which people find purpose and value. From this perspective, the authors recognize that the role of occupational therapy in the acute phase of care is to provide a practical assessment and approach to help patients achieve a quality of life on their own at an early stage. Significant differences were observed in the content of practice and intervention systems of occupational therapists in Japan, indicating that this field is still in its infancy. Therefore, this article aimed to understand better the role of multidisciplinary professionals, including occupational therapists, in the acute care setting. We also aimed to consider that this article will serve as a reference for occupational therapists working in the acute care setting.

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Showa University Karasuyama Hospital, located in Setagaya Ward, Tokyo, Japan, plays the role of a core psychiatric hospital with close ties to the local community and has a 94-bed psychiatric emergency ward （hereinafter referred to as “super emergency”）. Occupational therapists provide group-based occupational therapy （OT） in and out of the super emergency unit. In this study, we summarized the inpatients in the super emergency unit over a 2-year period and discussed the role of OT in the acute phase based on the utilization of OT by inpatients. A total of 1,006 patients were admitted over the 2-year period, and approximately 80％ were involuntarily admitted. Of the 617 discharged patients, 434 （70.3％） received OT prescriptions and 536 （86.9％） were discharged within 90 days. Many discharged patients used OT. At the entrance to the psychiatric care, a super emergency, they organized themselves, made connections with others, and experienced small successes. The priority is to integrate naturally into OT, which is based on a group that can be called a simulated society to affirm one’s existence, to achieve a sense of recovery, and to be ready to continue the treatment in the future.

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Speech-language therapy （speech therapy） covers a wide range of areas in acute care rehabilitation, including dysphagia, dysarthria, and communication disorders due to aphasia and other higher brain dysfunctions. The rehabilitation unit at Fujigaoka Hospital has employed speech-language-hearing therapists （speech therapists） since 2019, and the number of prescriptions has been increasing annually. To clarify the current status of speech therapy at Fujigaoka Hospital, a study on speech therapy performance was conducted in 2022. The results showed that 575 patients requested for a speech therapist in 1 year and that the target primary diseases were diverse. Dysphagia was the most common disorder targeted at the time of the initial intervention, indicating the increasing need to provide rehabilitation for acute dysphagia. About 67％ of patients received initial intervention speech therapists within 1 week of onset of illness, indicating that speech therapy is needed at an early stage. Swallowing and communication difficulties are common in patients with acute dysphagia, resulting in the high demand for speech therapy. However, only a few speech therapists are employed in acute care hospitals. To maintain and improve the quality of care provided to patients, collaboration with other health professionals should be strengthened, and methods to achieve high effectiveness with less-frequent intervention should be identified. Furthermore, to implement acute speech therapy more actively in hospitals affiliated to Showa University, educating speech therapists who can take charge of rehabilitation is urgently required in acute care settings. Furthermore, to demonstrate the necessity of acute speech therapy, further data should be accumulated to clarify the effectiveness of acute speech therapy in the acute stage.

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Patients with intractable chronic pain often suffer from sleep disorders. Vitamin D （VD） deficiency is a known factor in sleep disorders; however, it has not received much attention in Japan. Further, only few studies have reported about VD supplementation for sleep disorders in patients with chronic pain. Therefore, this study aimed to clarify the effect of VD supplementation in patients with chronic pain and sleep disorders. Patients with chronic pain of at least 3 months who visited the outpatient pain clinic between August 2018 and July 2022 were included. Sleep disturbances were assessed through the Japanese version of the Pittsburgh Sleep Questionnaire. Replacement therapy consisted of VD supplementation at a dose of 1,000IU/day for 3 months if 25-hydroxy VD was ＜20ng/ml in the blood. If it remained ＜20ng/ml even after 3 months, the dose was increased to 2,000IU/day. Of the 45 patients with chronic pain, 39 exhibited VD deficiency. Data from 28 patients, who were followed-up to the maturity of VD replacement therapy, were analyzed. After VD replacement therapy, its deficiency improved in all patients, and sleep disturbance scores showed significant improvement （p＝0.04）; however, chronic pain did not improve. Pain Scales （Numerical Rating Scale and short-form McGill pain questionnaire 2） correlated positively with the sleep disturbance score r＝0.46, （p＝0.01）; r＝0.61, （p＜0.01）. No patient experienced adverse events and the results suggest that VD replacement therapy is safe and improves sleep in patients with chronic pain.

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Radiation therapy plays an important role in the treatment of locally advanced non-small cell lung cancer （LA-NSCLC）. However, determining the optimal radiotherapy irradiation field for LA-NSCLC can be challenging. Herein, we analyzed the accumulated experience of radiotherapy for LA-NSCLC at Showa University Fujigaoka Hospital, to identify important considerations while creating radiotherapy treatment plans for LA-NSCLC. A total of 50 patients with LA-NSCLC who were treated with radiotherapy in our hospital were included in the study. The median overall survival and median progression-free survival times were 38.5 and 14.2 months, respectively. The two-year overall survival and two-year progression-free survival rates were 64.2％ and 32.1％, respectively. The treatment outcomes were similar to those reported by other researchers. Additionally, elective nodal failure occurred in two cases （4％）, both of which were upper lobe origin and treated with involved field radiation therapy. Elective nodal irradiation might be considered in cases of upper lobe origin unless the irradiated volume of the lung is elevated.

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Donor milk （DM） is recommended for preterm infants who are unable to breastfeed by themselves, which reduces the incidence of problems like necrotizing enterocolitis. However, prolonged use of DM alone is associated with poor weight gain. Herein, we experienced an extremely low-birth-weight infant who could not use his mother’s breast milk and was fed with DM until 34 weeks of corrected age. As the mother was unable to breastfeed because of congenital heart disease, DM enteral feeding was started at 9 hours of age. The infant showed a gradual deterioration in weight gain after birth. At 34 weeks of corrected age, his weight exceeded 1,500g, he was switched on to low-birth-weight formula, and his weight gain improved gradually. Moreover, he neither developed necrotizing enterocolitis nor did he require any treatment for retinopathy of prematurity during the course of his life. During the unavailability of autologous breast milk, nutrition from DM reduces the risk of many diseases and continues to provide important nutrition to preterm infants, including those with very-low-birth-weight. The poor weight gain reported as a disadvantage of nutrition from DM indicates the requirement for improved methods for the fortification of DM used on a long-term basis. In the U.S., human-derived breast milk fortification has been initiated and favorable results have been achieved using exclusive human milk nutrition. In the future, the use of human-derived breast milk fortification in Japan may lead to improved nutritional management for preterm infants.

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To prevent infection in newborns, early mother–infant contact and rooming, which are important for breastfeeding, are difficult for puerperas diagnosed with coronavirus disease 2019 （COVID-19）. A university hospital also separates mothers and infants as a preventive measure against infection in newborns; thus, effective breastfeeding support must be considered under these circumstances. Herein, a 30-year-old puerperal （gravida 1 para 0） who was diagnosed with COVID-19 delivered a 2,973-g newborn through cesarean section at 38 weeks and 5 days of gestation. She was under a lot of stress after being diagnosed with COVID-19, and we encouraged her to lactate, which was effective support until the actual breastfeeding. Additionally, we believe that （1） showing respect for self-determination, （2） making puerperals aware of what they can do as mothers, （3） providing support for coping behaviors to address difficulties in breastfeeding, and （4） giving immediate postpartum support serve as support for continuing breastfeeding. Moreover, uninterrupted and continuous support is necessary from birth to 4 months of age.

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