In Japan, the three major treatment options for gastric cancer are gastrectomy, endoscopic mucosal resection, and anticancer drugs (or combinations of the three). The surgical procedures are well established and the results are satisfactory, but there is no prospect of extending surgical approaches beyond the techniques that already exist. On the other hand, remarkable developments have been made in chemotherapy and molecularly-targeted therapy, and these have contributed to a reduction in deaths from gastric cancer. However, patients with gastric cancer that progresses to a certain level are classified as having systemic disease with an increased risk of postoperative recurrence. Therefore, adjuvant chemotherapy aimed at preventing recurrence, such as metastases or peritoneal dissemination, after surgery can be said to be an indispensable partner of surgical treatment. S-1 is still a key drug in gastric cancer treatment, and maintenance of nutrition and skeletal muscle mass after gastrectomy are important for the continuous use of S-1 after surgery. Taking skeletal muscle mass measurements after surgery is a useful and simple was to predict prognosis.
According to the National Cancer Center's Cancer Information Service, the number of people who died of cancer in Japan in 2017 was about 370,000, making it the leading cause of death among Japanese people and accounting for 1 in 3 deaths. Nevertheless, great progress has been made in the areas of cancer treatment and supportive care for patients with cancer, and most anticancer drugs are now available to outpatients, increasing the importance of outpatient care. With the aim of improving the management of cancer guidance services, the guidelines on charges for medical treatment and care were revised in 2014, and a fee for giving instruction to patients with cancer was introduced; the guidelines also specified the roles those providing medical care, including pharmacists, were expected to play. Previously, it was simple enough to calculate drug management instruction fees for inpatients, charges for drugs prescribed on the wards, etc., but the new instruction fee is the first one specifically aimed at pharmacists involved in cancer treatment for outpatients. In our hospital, we had already been providing drug guidance to outpatients with cancer, but we opened a new pharmacology outpatient clinic in April 2018 to provide guidance from specialists and accredited pharmacists with specialized knowledge about cancer. In this paper, we consider the current situation regarding the roles of pharmacists in treating outpatients in our hospital, along with potential that may arise in the future.
In the event of a major earthquake in the Tokyo metropolitan area, the number of people injured is predicted to be nearly 150,000 in Tokyo alone. Therefore, the Japanese government must be prepared to respond promptly by deploying medical teams and implementing appropriate medical systems in disaster-stricken areas with the support of base hospitals. Large-scale training of medical professionals is also required annually. Furthermore, all of these measures need to be validated. However, to date, no method has been established to validate measures for medical support activities after a disaster. In this study, we constructed a disaster medical simulation system using discrete-event simulation, reproduced the flow of medical support activities after a disaster, and quantified expected outcomes. The medical activity simulation was conducted in response to a hypothetical major earthquake in Tokyo. Results were assessed according to location by dividing Tokyo into the 12 districts specified as secondary medical districts by the Tokyo Metropolitan Government. The simulation time frame started from when an injury was first sustained due to the earthquake and concluded when all victims reached one of the following endpoints: admission to hospital, transport out of a staging care unit, or death. In this scenario, more than 3,000 yellow or red tag patients would be admitted to hospitals located in the Central Northeast and Central East districts of Tokyo, which is a very serious medical situation. In terms of load per hospital, affiliated hospitals in the Central East district can accept the largest number of yellow and red tag patients (more than 250) at one time, followed by affiliated hospitals in the Central South district, and disaster base hospitals and affiliated hospitals in the Central Northeast district. Under current assumptions for medical assistance, the disaster medical simulation system found that due to a lack of medical staff only 67.1% of yellow or red tag patients would survive a disaster through treatment, hospitalization, and wide-area medical transportation. In the future, it is hoped that this simulation system will be used to investigate and resolve bottlenecks for disaster medical care and to implement appropriate response measures.
A 52-year-old woman diagnosed at our hospital with breast cancer (ER−/PgR−/HER2−) with lymph node and bone metastasis was given systemic chemotherapy with epirubicin plus cyclophosphamide and zoledronic acid. This proved ineffective, so breast-conserving surgery with axillary lymph node dissection was performed for the purpose of local control and pathological evaluation. The pathological therapeutic effect was classified as grade 1, and the endocrine receptor status changed to positive. After surgery, the patient received chemotherapy with docetaxel plus cyclophosphamide twice and paclitaxel twice. Endocrine therapy was subsequently administered. One month after the start of endocrine therapy, the patient experienced pain throughout her body and fatigue, and a blood test showed thrombocytopenia. A bone marrow biopsy led to a diagnosis of disseminated carcinomatosis of the bone marrow resulting from metastatic breast cancer. Her symptoms did not improve even after hospital treatment, and she died 6 months after the breast surgery. This case of breast cancer resulting in rapid death from disseminated intravascular coagulation (DIC) caused by disseminated carcinomatosis of the bone marrow illustrates the urgent need for further consideration of the risk factors for this disease and determination of optimal therapy.
Stroke is clinically characterized by hemiplegia and exercise intolerance, both of which not only interfere with the ability to perform activities of daily living (ADL), but also significantly reduce quality-of-life (QOL). Neurological and functional recovery occurs mainly within the first 6 weeks after onset of stroke, but the process continues for several months, with maximal functional recovery usually achieved within 6 months. In Japan, convalescent rehabilitation wards play an important role in the rehabilitation of post-stroke patients who have impaired ADL and health status after the acute phase. Various physiotherapies have been developed to improve functional recovery in patients with hemiplegia due to stroke, including the facilitation technique with proprioceptive neuromuscular facilitation, and constraint-induced movement therapy. A novel facilitation technique is repetitive facilitative exercises (RFE), which promote the functional recovery of the hemiplegic limbs to a greater extent than conventional rehabilitation sessions.
Functional electrical stimulation (FES) is a technique used to produce contractions in paralyzed muscles by the application of small pulses of electrical stimulation to the nerves that supply the paralyzed muscle. FES is used as an orthosis to assist walking, and also as a means of practicing functional movements for therapeutic benefit. New training technologies involving the use of robots have recently been developed to help in the rehabilitation of post-stroke patients.
Robot-assisted rehabilitation therapy provides functional training of the upper and lower limbs in an effective, easy and comfortable manner. Furthermore, the robot-assisted training paradigm offers intensive, repetitive, sufficient, and accurate kinematic feedback along with symmetrical practice while reducing the workload for the therapist, thus reducing the cost of post-stroke rehabilitation. Exoskeleton-type robotic devices have robot axes aligned with the anatomical axes of the wearer. These robots provide direct control over individual joints, which can minimize abnormal posture or movement. Robot-assisted gait training is effective in the long term in improving balance and walking ability, and it has a positive impact on patients' QOL. Several well-designed studies have provided evidence that robot-assisted training promotes motor recovery and functional improvement in post-stroke patients. However, the evidence is insufficient to draw conclusions about the effectiveness because of small samples sizes, methodological flaws, and heterogeneous training procedures. More well-designed randomized controlled trials are needed.