The nurture of human resources with competency, who are capable of surviving the 21^st century, is a global challenge for all fields of education. Especially, education of healthcare professionals is proceeding with its reform from didactic- to competency-based education. At present, simulation-based education (SBE) is globally validated to be effective for the consolidation of learners' competency by integrating their knowledge and skills. In recent years, institutions in Japan have had growing interest in SBE; consequently, both software and hardware have been enriched to a considerable extent. Educators are currently required to have teaching skills that draw self-motivation from learners because SBE is “learner-centered” in nature. This article provides fundamental knowledge in expanding SBE and has an overview of trends in the practice and research of healthcare professional education in the world and Japan.

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Objective: Respiratory syncytial virus (RSV) infection sometimes causes respiratory failure after hospital admission, even if respiratory function seems normal on admission. We investigated initial risk factors of RSV infection in otherwise normal patients to predict respiratory worsening. Methods: We reviewed the clinical records of 87 patients with RSV infection admitted to the Yodogawa Christian Hospital between January 2011 and September 2013. We divided patients into the ventilated group and the control group according to their need for ventilatory support including noninvasive positive pressure ventilation and continuous negative mode of biphasic cuirass ventilation after admission, and we retrospectively analyzed characteristics, present medical conditions, and diagnostic tests. Results: A multivariable logistic regression analysis identified venous bicarbonate and abnormal findings on chest X-ray as independent risk factors for ventilatory support after admission. Conclusion: Normal patients with RSV infection who have the elevated bicarbonate on initial venous blood gas analysis or abnormal findings on chest X-ray (e.g., infiltration, atelectasis, or hyperinflation) may require ventilatory support after admission with careful monitoring.

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Objective: To investigate the relationships between the preoperative cognitive function and ICU-acquired delirium (ICU-AD) in patients who had undergone aortic surgery. Methods: The subjects were sixty-five patients who underwent elective aortic surgery. They were classified into the ICU-AD onset group and non-onset group. The data regarding the age, sex, BMI, medical history, mini-mental state examination (MMSE), type of operation performed, length of intubation, ICU days, the use or non-use of drugs such as sedative-analgesics, and the development of postoperative complications were compared between the two groups. Results: The incidence of ICU-AD was 27.6%. The preoperative MMSE in the ICU-AD group was significantly lower than that in the no ICU-AD group (25.1±3.9 vs 27.9±2.1, P<0.01). The preoperative MMSE was extracted as a predictor of ICU-AD by a logistic regression analysis. Furthermore, the cut-off value of the preoperative MMSE was 26.5 points [area under curve (AUC) 74%, 95%CI 0.580-0.891, P<0.01] by the receiver operating characteristic curve analysis of the preoperative MMSE. Conclusion: 26 or fewer points on the MMSE predicted the development of ICU-AD after aortic surgery.

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Management of hyponatremia in patients with syndrome of inappropriate antidiuretic hormone secretion (SIADH) is challenging and cumbersome for both patients and medical staff. This is partly because traditional treatments such as 3% hypertonic saline correct hyponatremia by increasing sodium intake. By contrast, administration of tolvaptan, a vasopressin-2 receptor antagonist, corrects hyponatremia by increasing free water excretion, and has recently been reported as a rapid and efficient treatment of hyponatremia. We here report a case of severe SIADH secondary to small-cell lung cancer (SCLC) treated with tolvaptan in the acute and subacute settings without serious adverse effects. An 80-year-old man was admitted to our hospital due to disturbed consciousness and a serum sodium level (SSL) of 103 mmol/l. He was diagnosed with SCLC and severe SIADH. Consequently, we administered tolvaptan (7.5 mg, orally). With close monitoring of the SSL and urine output every 6 hr during the initial phase, the SSL increased 4-10 mmol/l/day without severe adverse effects. The SSL reached 130 mmol/l, and his clinical symptoms ameliorated on the fifth day of hospitalization. Due to his terminal-stage SCLC, the same dose of tolvaptan was continued as palliative care. The SSL remained adequate for >3 months, and no neurological deficits were observed. Administering tolvaptan may represent an effective therapeutic approach in the acute and subacute phases of SIADH and may hence contribute considerably to their quality of life.

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Lemierre's syndrome is a serious infectious disease characterized by thrombophlebitis of the internal jugular vein and thrombosis propagating into the lungs and other organs following a prolonged history of bacterial pharyngitis. If this uncommon condition is suspected, preemptive broad-spectrum antibacterial therapy should be initiated immediately to prevent enlargement and propagation of the inflammation. This paper describes a patient with Lemierre's syndrome who presented with pyrexia and dyspnea and was diagnosed by the identification of left internal jugular venous thrombosis, Gram-negative anaerobic (primarily, Fusobacterium necrophorum) bacteremia, and bilateral pleural effusion and empyema. Prompt antimicrobial therapy ameliorated the general condition of the patient, while intrapleural instillation of urokinase with chest drainage successfully treated the empyema. This experience re-emphasizes the importance of early and appropriate interventions for the cure of this syndrome and suggests that in case of coexistence of empyema, intrapleural fibrinolytic therapy with chest drainage is worth trying because of its reduced risk of inducing systemic adverse effects.

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We report a case of cardiac arrest in a young man in his late teens that was caused by overdoses of drugs (including cibenzoline, class Ia antiarrhythmic agent), which were prescribed for his family. He had no history of past illness, including any type of psychiatric disorder. The patient took 30 cibenzoline (100 mg) tablets, 118 valproate sodium (200 mg) tablets, 28 brotizolam (0.25 mg) tablets, and 34 ibuprofen (100 mg) tablets in his home. He was transported to our emergency department 70 minutes after taking these drugs. While an electrocardiogram showed complete right bundle branch block, he had stable hemodynamics at the time of admission. Fifteen minutes after his arrival, the electrocardiogram indicated ventricular tachycardia and eventually led to pulseless electrical activity. A percutaneous cardiopulmonary support device was used because of ineffectiveness of advanced cardiac life support. After admission to the intensive care unit, he was treated with plasma exchange and percutaneous cardiopulmonary support. His cardiac output then gradually increased. He recovered with no neurological sequelae and was discharged from the hospital 10 days after admission. Class Ia antiarrhythmic agent intoxication caused by an overdose is rare. Clinicians should be able to treat this intoxication based on the mechanism of action. In severe cases, as the initial response, physicians should consider using mechanical circulatory support when there is acute circulatory insufficiency. Additionally, appropriate blood purification therapy should be selected if required.

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Acute epiglottitis is a condition requiring immediate medical attention, as it can potentially cause airway obstruction, and, in emergency situations, it needs to be determined whether urgent airway management should be performed. However, indication criteria for airway management have yet to been established. To clarify the clinical picture of acute epiglottitis when it requires airway management, we conducted a retrospective observation study on patients admitted to our hospital with acute epiglottitis. Among the 62 cases investigated, airway management was performed in 10 cases (16.1%), of which six cases (9.7%) underwent surgical airway management through emergency outpatient care within 48 hours from the onset of symptoms. Univariable analysis showed significant differences between the airway group and non-airway group in seven items, including the histories of smoking, throat infection, and diabetes. Multiple logistic regression analysis found three factors that influence airway management, which were: history of smoking, difficulty in speaking, and after-hours visits. The practice of acute epiglottitis, it is necessary management system that evaluates the airway emergency risk and enables airway management quickly. In this study, history of smoking, difficulty in speaking, and after-hours visits are related factors of airway management.

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