Satou 10) , Tatsunori Shimoi 11) , Keita Tagami 12) , Yuuta Esumi 13) , Daisuke Sakai 14) , Takahiro Kogawa 15) and Tatsuya Morita 16) Background: The demand for palliative care in Japan has risen over recent years, and training of palliative care physicians is an important problem. However, little is known about unmet needs for education and training systems as well as career development among young physicians who wish to specialize in palliative care. Purpose: To explore unmet needs among palliative care physicians in training. Method: We held group discussions in a forum for physicians of postgraduate year≦15, and analyzed their opinion on topics such as "what are unmet needs?" using theme analysis. Results: Forty physicians participated. Theme analysis revealed the following unmet needs among young physicians; "securing of manpower", "securing of quality of training programs/education", "improvement of network", "removal of many barriers to keeping on a palliative care physician", and "establishment of career models for a specialist". Conclusions: We should discuss solutions for the unmet needs to secure more palliative care physicians.
Introduction:】To our knowledge, there is only one report of lactic acidosis in a patient with prostate cancer and no such report in Japan. We describe a patient with terminal stage prostate cancer who showed marked elevation in lactate dehydrogenase (LDH) levels and lactic acidosis. Case Report: The patient was a 66-year-old man diagnosed with prostate cancer and bone and liver metastases. At the time of diagnosis, he was being treated with the best supportive care after chemotherapy and hormone therapy for prostate cancer. He was admitted to the hospital for nausea and loss of appetite. Laboratory tests showed elevated LDH levels (11,894 IU/L; LDH4, 23%; LDH5, 32%); pH, 7.402; pCO 2 , 13.2 mmHg; HCO 3 − , 8.0 mmol/L; and lactate level, 10.0 mmol/L. On the basis of the results, the patient was diagnosed with lactic acidosis. He showed tachypnea the day before his death. Conclusion: Elevation in LDH levels, and especially of LDH5, indicates acceleration of anaerobic glycolysis from tumor cells, leading to the accumulation of lactate. The patient's tachypnea was possibly caused by lactic acidosis.Palliat Care Res 2015; 10(3): 539-42
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