A Patient with Cancer Pain Developing Serotonin Syndrome and Concomitant Acute Dyskinesia Associated with Tramadol Hydrochloride

A 68-year-old man with a diagnosis of transformation to undifferentiated carcinoma of the left thyroid who was being treated with Lenvatinib presented with swelling and pain around the left clavicle, and tramadol was started. Two days later, he developed diarrhea, sweating, disorientation, and myoclonus, leading to a diagnosis of serotonin syndrome. He also exhibited dyskinesia including involuntary movements of the arms and legs and squirming movements of the trunk. Tramadol was thus discontinued. His myoclonus and dyskinesia resolved within half a day and had disappeared the day after tramadol discontinuation. These symptoms were attributed to tramadol because there was a reasonable temporal relationship between drug administration and the adverse event. Tramadol inhibits serotonin reuptake, and thus has the potential to cause serotonin syndrome. However, there have been relatively few reports describing the occurrence of this syndrome, and there have been none showing concomitant dyskinesia. Clinicians should be aware that tramadol can cause serotonin syndrome accompanied by dyskinesia.

A case that Goshuyuto was effective for intractable hiccups caused by the medulla oblongata dissemination of the cerebellum melanoma

<b>Introduction:</b> Goshuyuto was effective in a case with intractable hiccups caused by the medulla oblongata dissemination of the cerebellum melanoma. <b>Case:</b>A 54-yearold male patient was diagnosed cerebellum malignant melanoma. He suffered from intractable hiccups caused by the medulla oblongata dissemination lesion of this melanoma. He was treated with some Western medicines such as Baclofen, Metoclopramide, Chlorpromazine and Clonazepam, which are usually used for the treatment of hiccups, but they were not effective. Therefore we gave him Goshuyuto which is Kampo medicine and his hiccups subsided immediately. Since then, he continues taking Gosyuyuto about a year and there has been no recurrence of hiccups thus far. <b>Conclusion:</b> Taking of Kampo medicine is the useful choice for a patient whom Western medicine is ineffective.

Care Cafe® effects on local integration：using mixed method

<b>Objective：</b>Care Cafe® aims to remove the barriers between medical treatment, nursing, and welfare, particularly with regard to actual practice. This study was conducted to investigate the changes in local integration using the Care Cafe®. <b>Method：</b>Participants in Care Cafe® filled out the questionnaire before and after attending. We used the Mixed Method to compare the results. This method provides analysis on changes in“quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region”scale points, as well as content analysis on the free-opinion space. <b>Results：</b>The“quantify the quality of communication and cooperation”scale points increased significantly overall, as well as on the subscale. The effect size ranged form 0.32 to 0.36. We also had various successes in the content analysis of the free-opinion space, such as building face-to-face relationships in multiple occupations, that being one of the main purposes of Care Cafe®, as well as providing support, learning through discussion, and generating social capital. <b>Conclusion：</b>Care Cafe® may be a useful tool for improving local, multi-discipline cooperation involving medical treatment, nursing, and welfare.

A measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region

<b>Purpose</b>: This study was conducted to verify the reliability and validity of a scale evaluating the quality of communication and cooperation among medical, nursing, and welfare services in a region. <b>Methods</b>: To apply "a measure to quantify the quality of communication and cooperation among health care providers in a region" (Morita et al, 2013) developed for health care professionals engaged in the care of homebound patients to broader profession and disease categories, the measure was modified to newly establish the 26-item "measure to quantify the quality of communication and cooperation among medical, nursing, and welfare services in a region." In total, 362 health care professionals were enrolled in this study. <b>Results</b>: The internal consistency was excellent. Exploratory factor analyses identified the factor structure as being identical to that of the original scale. The total score had negative but significant correlations with subscales for difficulties in regional cooperation on the Palliative Care Difficulties Scale. The total score was also significantly associated with the general evaluation of communication and cooperation in the region, the number of participations in whole-region multidisciplinary conferences, and the number of persons to whom the respondent could inquire about support. <b>Conclusion</b>: This scale may be useful for describing the extent of global communication and cooperation among medical, nursing, and welfare services in a region.

Care Café for healthcare professionals─blending communities

<b>Aim</b>: Many methods aiming to achieve face-to-face, multi-discipline healthcare cooperation have been attempted in Japan in order to optimize the community care system. There are however, many obstacles to the commencement or successful coordination of meetings, seminars, and workshops for health care professionals, particularly longterm cooperation and financial constraints. We have developed methods to solve these problems. <b>Methods</b>: We invented a new method, called Care Café based on the philosophical and sociological ideals utilized by the World Café. Care Café is held on a regular basis to facilitate communication and cooperation between healthcare professionals with the aim of finding solutions to mutual problems. <b>Results</b>: Care Café has been held on a monthly basis in Asahikawa, where it started. There have been 9 Care Café events in Asahikawa so far, with the number of healthcare professionals in attendance totaling approximately 700. The concept of Care Café is earning greater recognition in Japan, and Care Café events have now been held in 16 different Japanese cities, for an aggregate total of 29 events nationwide. We have received Care Café reports from participating cities detailing successful multi-discipline healthcare cooperation in solving medical issues. <b>Conclusions</b>: Care Café started in Asahikawa. It has been spreading among healthcare professionals nationwide. We expect Care Café to establish and develop new face-toface, multi-discipline healthcare cooperation.

Changes attained through the Palliative Care Education Program based on Cancer Control Act of Japan from the trainers' perspective

<b>Purpose</b>: The Palliative Care Education Program based on the Cancer Control Act has been held throughout Japan since 2008. The aim of this study is to identify changes attained through the program from the trainers' perspective. <b>Method</b>: The contents of the brain-storming sessions with the twelve trainers were qualitatively analyzed. <b>Results</b>: Six main categories of improvement were identified. These include: Reinforced cooperation; improved palliative care skills and knowledge; improved awareness of palliative care; improved understanding of the local palliative care resources; behavior modification of the participants; and development of in-hospital palliative care systems. <b>Conclusion</b>: Trainers recognized that holding the Palliative Care Education Program provides not only direct results such as greater knowledge and improved delivery of palliative care by physicians, but also indirect results such as enhanced cooperation and improved awareness of local palliative care resources.

Current problems with project management and learning materials of a palliative care education program for physicians based on the Cancer Control Act

<b>Background</b>: In order to improve physicians' competence of palliative care, the PEACE project, a palliative care education program for physicians based on the Cancer Control Act, has been conducted throughout the country since 2008. The effectiveness and limitations of the current project management techniques and learning materials have not been determined. This study aimed to explore current problems with the PEACE project and to seek corrective strategies. <b>Method</b>: A workshop was held with 36 participants who had finished PEACE faculty-development programs, and involved brain-storming with physicians. The results of brain-storming sessions were qualitatively analyzed. <b>Results</b>: Most problems identified related to the burden, to the host, of holding the faculty-development program workshop. In addition, some problems related specifically to the individual host site or community involved. <b>Conclusion</b>: One strategy to improve these problems is to incorporate e-Learning to both expand the program and reduce the burden on the host site. In addition, workshop materials could be improved to include additional modules and revised guidelines. Palliat Care Res 2011; 6(2): 143-149