Saiseikaisenri Hospital

要旨 【目的】 メディカルラリーはチーム医療や多職種連携を体験的に学ぶシミュレーション教育である。本研究では，メディカルラリー参加前後でのアンケートを通じて，医療系学生における救急医療への興味や多職種連携への理解に及ぼす教育的効果を検証した。 【方法】 参加学生110名のうち，事前・事後アンケートに回答した45名を対象とした。アンケートでは，「救急医療への興味」，「他職種の役割や知識・技術の理解」，「他職種との連携の必要性」を5段階リッカート尺度で調査し，参加前後の変化を評価した。 【結果】 「他職種の役割や知識・技術の理解」では，肯定的回答が34%から51%に増加し，否定的回答は42%から7%に減少した。一方，「救急医療への興味」および「多職種連携の必要性」については，有意な変化を認めなかった。 【結語】 メディカルラリーは，多職種連携の理解を深める有効な教育手法であることが示唆された。一方で，救急医療に対する興味の変化は限定的であり，その教育効果をより正確に評価するためには，対象層や募集方法を考慮した検討が必要である。

Immunotherapy with immune checkpoint inhibitors (ICI) has recently been introduced to advanced and recurrent endometrial cancers. The addition of durvalumab to standard carboplatin-paclitaxel (TC) therapy improved outcomes for patients with endometrial cancer. However, immune-related adverse events (irAEs) are being increasingly recognized, and neurological irAEs are rare, particularly those confined to the cerebellum. We present the case of a 55-year-old woman with recurrent endometrial cancer who developed acute neurological symptoms during treatment with TC plus durvalumab therapy. The patient presented with an unsteady gait, and initial brain magnetic resonance imaging excluded cerebral infarction. As her symptoms persisted, the patient was transferred to a tertiary neurology hospital. Neurological examinations revealed truncal ataxia, dizziness, dysarthria, and nystagmus. Based on neurological findings, cerebrospinal fluid and blood analyses, and the clinical course, the patient was diagnosed with immune-related cerebellitis. Chemotherapy was discontinued as the event was graded as a severe (grade 3) irAE. High-dose corticosteroid pulse therapy was administered twice, followed by intravenous immunoglobulin (IVIG), owing to an incomplete response. Despite treatment, nystagmus persisted. Although no disease progression was observed, her quality of life (QOL) was profoundly impaired, and supportive care was initiated.Neurological irAEs can cause irreversible sequelae and significantly impair QOL. When neurological symptoms are observed during ICI therapy, prompt collaboration with a neurologist and early intervention are essential to minimize long-term disability. This case highlights the importance of vigilance for rare neurological irAEs, such as immune-related cerebellitis in gynecological oncology practice.

We aimed to assess the association between base excess (BE) levels and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA), accounting for the time from cardiac arrest onset to blood sampling. This multicentre study was conducted in Osaka, Japan, and enrolled consecutive patients with OHCA who were transported to 16 medical centres between 2012 and 2021. Patients aged≥18years with witnessed OHCA and available BE measurements upon hospital arrival were examined. Patients were stratified into Q1 (BE≤-21.1mmol/L), Q2 (-21.1<BE≤-15.7mmol/L), Q3 (-15.7<BE≤-10.4mmol/L) and Q4 (BE>-10.4mmol/L) groups based on BE levels. The primary outcome was 1-month survival with a favourable neurological outcome (Cerebral Performance Category scale score: 1 or 2). Among the 23,854 patients with OHCA, only 6066 were included in the final analysis. Approximately 3.2%, 4.7%, 9.9% and 23.7% of patients in the Q1, Q2, Q3 and Q4 groups, respectively, achieved favourable neurological outcomes at 1month. Compared with Q4, the adjusted odds ratio for a favourable neurological outcome in Q1 was 0.13. Subgroup analysis revealed a significant interaction between prehospital return of spontaneous circulation (ROSC) and neurological outcomes; neurological outcomes worsened as BE decreased in patients with ROSC but not in those without ROSC. Lower BE levels upon hospital arrival are associated with poorer neurological outcomes and may serve as prognostic indicators in patients with OHCA who achieved prehospital ROSC.

Abstract Background Cardiac arrest leads to an abrupt cessation of blood flow, resulting in severe metabolic acidosis. Base excess (BE) is a widely used marker of metabolic acidosis. However, its prognostic value in cardiac arrest patients remains unclear, as previous studies have not adjusted for the time from arrest to blood testing. This study aimed to assess the association between BE levels and neurological outcomes in patients with out-of-hospital cardiac arrest (OHCA) by adjusting the time from the onset of cardiac arrest to blood tests. Methods This study in Osaka, Japan, enrolled consecutive patients with OHCA transported to 16 centres between 2012 and 2021. We included adult patients (age ≥ 18 years) with witnessed OHCA and available BE levels upon hospital arrival. The patients were grouped based on BE quartiles: Q1 (BE ≤ − 21.1 mmol/L), Q2 (− 21.1 &lt; BE ≤ − 15.7 mmol/L), Q3 (− 15.7 &lt; BE ≤ − 10.4 mmol/L), and Q4 (BE &gt; − 10.4 mmol/L). The primary outcome was 1-month survival with favourable neurological outcomes, defined as a Cerebral Performance Category scale score of 1 or 2. Results Of the 23,854 patients with OHCA, 7,591 met the inclusion criteria, and 6,066 were eligible for analysis. The 1-month favourable neurological outcomes based on BE quartile were 23.5%, 9.8%, 4.7%, and 3.2% Q4, Q3, Q2, and Q1, respectively (p for trend &lt; 0.001). The adjusted odds ratio for Q1 compared with Q4 was 0.13 (95%CI: 0.090–0.19). Subgroup analysis showed an interaction between prehospital return of spontaneous circulation (ROSC) and outcome (p for interaction &lt; 0.001); neurological outcomes worsened as BE decreased in those with ROSC (p for trend &lt; 0.001), but not in those without ROSC (p for trend = 0.12). Conclusions Lower BE levels upon hospital arrival are associated with worse neurological outcomes and may serve as prognostic indicators, especially in patients with OHCA and prehospital ROSC.

Background: Disruptions in activity‐rest rhythms are common in terminal cancer patients, yet continuous monitoring of these changes is challenging. The effects of opioids and psychotropic drugs on sleep quality remain inadequately understood. Objectives: (i) To objectively evaluate temporal changes in diurnal (8:00 a.m.–8:00 p.m.) and nocturnal (8:00 p.m.–8:00 a.m.) activity‐rest rhythms over the final 2 weeks of life in terminal cancer patients using a nonwearable actigraph and (ii) to assess the adjusted impact of opioid and psychotropic drug use on these rhythms. Design: A longitudinal study. Settings/Participants: Twenty‐six terminal cancer patients in a Japanese palliative care unit. Measurements: A nonwearable actigraph was placed under the mattress to continuously monitor activity‐rest rhythms. Measured parameters included time in bed (TIB: minutes), total sleep time (TST), wake after sleep onset (WASO), sleep efficiency (SE: 0%–100%), activity score (0–960 counts/min; higher values indicate greater activity), and movement index (MI: percentage of time moving in bed; higher values suggest restlessness). Results: As death approached, diurnal TIB and SE increased, indicating reduced daytime activity. Nocturnal sleep metrics fluctuated irregularly, with an increase in MI, suggesting deteriorating sleep quality. Opioid users exhibited a higher MI and lower SE both day and night compared to nonusers. Psychotropic drug users showed a decreased nocturnal MI and improved SE. Conclusion: Terminal cancer patients experience decreased daytime activity and unstable nocturnal sleep as death nears. Opioid use correlates with inadequate rest, while psychotropic drugs may enhance nocturnal sleep quality. Continuous nonwearable monitoring offers valuable insights for optimizing end‐of‐life care.

This study aims to analyze the influence of leadership and work motivation on teacher work discipline. This type of research is quantitative research. The sample of this research was 106 teachers of SD Negeri Gugus 1, Sungaiselan District. Data collection tool using a questionnaire. Data analysis using multiple regression test techniques. The results of the study stated that (1) there was a significant influence between leadership on the work discipline of SD Gugus 1 teacher in Sungaiselan District; (2) There is a significant influence between work motivation on the work discipline of SD Gugus 1 teachers in Sungaiselan District; (2) There is a significant influence of leadership and work motivation on the work discipline of SD Gugus 1 teachers in Sungaiselan District together by 94.2% and the remaining 6.8% is influenced by other factors not examined in this study.

This study aims to describe and analyze the Payuang Sarampak Dance Movement in Sanggar Lindang Urek, East Payakumbuh District, Payakumbuh City. This type of research is qualitative using descriptive methods. Data were obtained by literature study, observation, interviews and documentation. The object of research is Payuang Sarampak Dance at Sanggar Lindang Urek. The main instrument is the researcher himself and requires tools in collecting data in the field, namely stationery and cellphone cameras. Data analysis techniques are by means of data collection, data reduction, data presentation and data examination. The results showed that Payuang Sarampak Dance in Sanggar Lindang Urek, East Payakumbuh District, Payakumbuh City was arranged by Bambang Irawan and the results found were aspects of space, time and energy of Payuang Sarampak dance. The process of creating Payuang Sarampak dance began with Mr. Bambang Irawan inspired by everyday life, namely the association of Minangkabau youth and women who still uphold customs and religion. This dance has 23 varieties of movements. The costumes used by female dancers are baju kurung, songket, tokah, suntiang, necklace, koteh-koteh, lame, laca and flowers for headdress. While male dancers wear purple loose clothes, black pants, scarves, sides, belts and use headdresses. The musical instruments used are gandang, bass guitar, violin, hi-hat, talempong, bansi, sarunai, accordion and tasa.