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Falcom Sound Team jdkについて 目次 [非表示] Falcom Sound Team jdk とは？ Falcom Sound Team jdk の慣習 進捗状況 Falcom Sound Team jdk とは？ + English What is Falcom Sound Team jdk? After Yuzo Koshiro (who succeeded as a composer with Ys I II and Sorcerian) left the company, Mieko Ishikawa (who debuted with the MSX version of Xanadu) became Falcom's sole composer, and worked alone on Sorcerian's additional scenarios, Star Trader and Ys III. The first mention of “J.D.K.” appeared in Star Trader, released in March 1989. According to the official book Falcom Music Chronicle, this unit was founded in late 1988, and all activity by Falcom's sound staff since then has been attributed to this new alias. This same unit was rebranded as “Falcom Sound Team J.D.K.” in 1991, in order to distinguish it from “J.D.K. BAND” – a freelance band that specializes in arranging and performing Falcom music. With the release of Revival Xanadu in March 1995, both “J.D.K.” units were renamed to “Falcom Sound Team jdk” and "jdk BAND”. The meaning of “jdk” and the reasons behind its formation are still shrouded in mystery. Since the formation of the sound team unit, all internal composition and arrangement activities are credited to “Falcom Sound Team jdk”. Its integrants are mentioned during the ending credits, but whoever is in charge of each song is not disclosed at all. In addition, all soundtracks produced prior to the formation of Sound Team jdk (before late-1988) has been retroactively credited as such, including all of Koshiro's Falcom work. Similarly, “J.D.K. (jdk) BAND” also exists as an unit with the name J.D.K (jdk), but they are essentially a separate group specialized in live performances. The sound team is made up of internal employees, while the band consists of a group of freelance musicians who are not Falcom employees. The songs intended to be performed by jdk BAND are arranged by the band's leader/director. · The first generation of J.D.K. BAND (1990~1996) was led by Tomohiko Kishimoto. Kishimoto was the band's leader, lead vocalist, lyricist, synthesizer/drum programmer and in charge of all their arrangements, and also performed guitar and bass at times. · The second generation of jdk BAND (2007~2015) was directed by Yukihiro Jindo, who also composed and arranged music for Falcom as a contractor, along with drummer Toshiharu Okajima and keyboardist Noriyuki Kamikura. · The third generation (2015~Present) is directed by Mitsuo Singa, who also provides compositions and arrangements for Falcom as a contractor. All performers from the second generation were replaced by newcomers. Falcom Sound Team jdk rules Handles not only music composition and arrangement, but also everything else related to sound, such as SE production and voice editing as well. Since Falcom is a small company, it is not uncommon for employees to work concurrently in other tasks and duties. Sound Team jdk members are no exception. If an employee isn't enrolled in Falcom when a game is released, their name will be removed from the in-game credits, no matter how many songs they have composed. In recent years, Falcom has often used previously rejected songs made in the past in newer games, including by former composers after they leave. Contractors usually get an "Arrangement" credit on album booklets. Sometimes this is true, but others is not and the "arrangers" are actually "composers". However, ever since Tokyo Xanadu (or more specifically since Mitsuo Singa appeared), the "Arrangement" (Composition) credit for independent contractors has been lost (except for vocal songs). (English text provided by Josep. I recommend the "Nihon Falcom (Sound Team J.D.K./jdk) Composer Breakdown Project" created by Josep and others to foreigners.) 「イース」や「ソーサリアン」で作曲者として大成功を収めた古代祐三氏が「イースII」で退社後、ファルコムのサウンドスタッフは「イース」でデビューをした石川三恵子氏ただ一人となる。ソーサリアンの追加シナリオなどで石川氏が一人孤軍奮闘したのち1989年3月発売の「スタートレーダー」のクレジットにて初めて『J.D.K.』の名前が世に出ることになりこのタイトルからサウンドスタッフは全員ひと括りにされチーム制度となる。1991年に曲のアレンジと演奏を専門とする『J.D.K.BAND』の発足を機にそれぞれのチームを区別するため『Falcom Sound Team J.D.K.』へ改名。1995年3月に発売された「リバイバルザナドゥ」以降から『Falcom Sound Team jdk』へさらに改名された。"jdk"の意味、結成した理由などはいまだ謎に包まれたままである。 2013年6月当時のボイスや効果音の入れ込み作業風景 左からjdkメンバーの萩生田朋克氏, 宇仁菅孝宏氏, 園田隼人氏, 籾山紗希氏 (情報源YouTube) Voice and sound effects working in June 2013 From left to right, jdk members Mr.Hagiuda, Mr.Unisuga, Mr.Sonoda, Ms.Momiyama サウンドチームが結成されて以降、ファルコム社内での作編曲は全て『Falcom Sound Team jdk』及び『J.D.K.』の名のもとにおこなわれるようになった。ただしエンドロールクレジットなどでそのゲームタイトルに関わったメンバーだけは最低限公表されるが曲別の担当はサウンドトラックでも一切明かされない。またサウンドチーム結成以前の曲でも結成以降に発売されたタイトルやサウンドトラックなどは全て『Falcom Sound Team jdk』名義に変更されている。 このことに関して海外メディアからインタビューを受けた白川篤史氏によると”「個々のメンバーの名前がクレジットされないのはチームとしての総合的な働きに焦点を当てたかったからだと思います。また個人の仕事量が公平かどうかで揉めるのを防ぐためでもあったのでしょう。」(*1)”と答えている。実際この方針を通じて幾ら年月が経ってもメンバー構成が変わっても「ファルコムサウンド」というブランドイメージを継続して維持出来たこともまた事実である(*2)。 ただ、誠実なスタッフクレジットをしてくれないことは消費者の立場からみてかなり不親切なこともまた確か。比較対象としては適切ではないが2017年にコナミが自社のサウンドスタッフを「BEMANI Sound Team」名義に変更しようとしてファンから猛反発を買い撤回した例があるほど。それだけゲーム音楽においてファンがクリエイターの個性を重視している証と言える。Falcom Sound Teamが発足した三十数年前ならいざ知らず、情報公開が進んだ今の時代、作曲者の曲別クレジットをしないゲーム会社は非常に稀であり時代に反しているように思える。ただこの秘密主義のお陰でそのヴェールを剥がそうとするマニア層コミュニティが中国や欧米を中心に形成されていき(*3)結果様々なリークに繋がることになったのは皮肉な話だがある意味当然の成り行きでもあったのだろう。 ちなみに同じくJ.D.K.(jdk)の名を持つチームとして『J.D.K.(jdk)BAND』が存在するが彼らは基本的に演奏を専門とするチームである。『Falcom Sound Team jdk』はファルコム社員で構成されるがバンドチームは社員ではないフリーのミュージシャンの集まりである。なので彼らはサウンドチームの正式メンバーではない。演奏をする曲は原則的にバンドチームのリーダーが編曲をおこない初代jdkBANDリーダーでは岸本友彦氏によって様々な編曲がなされライブなどが開かれた。さらに神藤由東大氏をリーダーとする2代目jdkBANDでは編曲だけでなくタイトルによっては作曲もおこなうようになり神藤氏、岡島俊治氏、上倉紀行氏が精力的に活動をした。3代目ではリーダーの真我光生氏のみが作曲をおこなうようになっている。 ↑PAGE TOP Falcom Sound Team jdk の慣習 ※過去に存在した公式企画「ふぁるコラム」やスタッフインタビューなどからの情報による。 音楽の作編曲だけでなくSE制作、音声編集など音にまつわることはなんでもおこなっている。 ファルコムでは音楽スタッフを含めて社員が他の分野の仕事を兼任していることは珍しくない。 ゲーム発売時にファルコムに在籍していなかった場合は採用された曲があったとしてもエンドロールクレジットには載らない。 現行・退社音楽スタッフが過去に作った曲の再利用をおこなっている場合が多い。 外注の音楽スタッフは基本的に編曲としてクレジットされるが本当に編曲のときもあれば実際には作曲を行っていることもある。 東亰ザナドゥ以降、さらに言うと外注の音楽スタッフ真我光生氏が参加し始めて以降は外注スタッフの編曲(作曲)クレジットは歌もの以外載らなくなっている。 ↑PAGE TOP 進捗状況 ゲーム内のサウンドクレジットが「Falcom Sound Team jdk (J.D.K.)」となって以降、また編曲者が公式に明らかにされていない作品のみを取り上げる。 （ = 解明済み / = 大凡解明しているが一部不明瞭 / = 当Wikiにより推測済み / = 未解明） 発売年 タイトル 1989 03 スタートレーダー 07 ワンダラース・フロム・イース 12 ドラゴンスレイヤー英雄伝説 1990 12 ダイナソア 1991 03 ロードモナーク 10 ブランディッシュ 11 アドバンスド ロードモナーク 1991 12 ぽっぷるメイル 1992 03 ドラゴンスレイヤー英雄伝説II 1993 03 ブランディッシュ2 -THE PLANET BUSTER- 11 イースIV -MASK OF THE SUN- 12 イースIV -The Dawn of Ys- 1994 02 風の伝説ザナドゥ 03 英雄伝説III -白き魔女- 06 ぽっぷるメイル SFC版 11 ブランディッシュ3 1995 04 リバイバルザナドゥ 06 風の伝説ザナドゥII 12 イースV -失われた砂の都ケフィン- 12 リバイバルザナドゥII 1996 05 英雄伝説IV -朱紅い雫- 10 ブランディッシュVT 12 ロードモナーク・オリジナル 1997 04 新英雄伝説 Win版 06 ソーサリアン・フォーエバー 1997 11 ファルコムクラシックス 12 ヴァンテージマスター 1998 03 英雄伝説III -白き魔女- PS版 04 イース エターナル 08 英雄伝説IV -朱紅い雫- PS版 10 モナークモナーク 12 ブランディッシュ4 -眠れる神の塔- 1999 04 英雄伝説III -新・白き魔女- Win版 12 英雄伝説V -海の檻歌- 2000 07 イースII エターナル 12 英雄伝説IV -朱紅い雫- Win版 2001 06 イースI 完全版 06 （交響曲イース -21st Century-） 09 （交響曲「ガガーブトリロジー」） 12 ツヴァイ!! 12 （イース・ヒーリング） 2002 06 VM JAPAN 06 （交響幻想曲「白き魔女」） 12 ダイナソア -リザレクション- 12 （ツヴァイ!! スーパーアレンジバージョン） 2003 09 イースVI -ナピシュテムの匣- 2004 06 英雄伝説 空の軌跡 12 ぐるみん 2005 06 RINNE 06 イース -フェルガナの誓い- プレアレンジ版 10 ザナドゥ・ネクスト 2006 03 英雄伝説 空の軌跡SC 12 イース・オリジン 2007 06 英雄伝説 空の軌跡 the 3rd 2008 12 ツヴァイ2 2009 09 イースSEVEN 2010 07 イースvs.空の軌跡 オルタナティブ・サーガ 09 英雄伝説 零の軌跡 2011 09 英雄伝説 碧の軌跡 2012 07 那由多の軌跡 09 イース -セルセタの樹海- 2013 09 英雄伝説 閃の軌跡 2014 09 英雄伝説 閃の軌跡II 2015 09 東亰ザナドゥ 12 英雄伝説 空の軌跡SC Evolution 2016 07 イースVIII -Lacrimosa of DANA- 07 英雄伝説 空の軌跡 the 3rd Evolution 08 英雄伝説 暁の軌跡 09 東亰ザナドゥ eX+ 2017 05 イースVIII -Lacrimosa of DANA- PS4版 09 英雄伝説 閃の軌跡III 2018 09 英雄伝説 閃の軌跡IV -THE END OF SAGA- 2019 09 イースIX -Monstrum NOX- 2020 08 英雄伝説 創の軌跡 2021 09 英雄伝説 黎の軌跡 2022 09 英雄伝説 黎の軌跡II -CRIMSON SiN- 2023 xx イースX -NORDICS- ↑PAGE TOP 免責 ※当wikiは非公式です。情報の妥当性や正確性について保証するものではなく一切の責任を負いかねます。 ※当wikiを利用することによって生じるいかなる損害も当サイトでは補償致しません。 ※ご利用につきましては自己責任となりますのでご注意ください。 ※また当wikiおよび当wiki管理人は日本ファルコム様とは一切関係がありません。 ※文章の著作権は当wikiにあります。内容の複写、転載はお控えください。 ※無料のウィキサービスを利用しているためこちらとは関係のない広告が表示されます。ご理解ください。 Disclaimer ※This wiki is unofficial. 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The term digital marketing or digital marketing has been from the past two decades as a subset of marketing management as well as advertising management. But due to the development of information technology in recent years, the increase in the average online user’s time, the widespread use of mobile phones and the increase of the penetration rate of the Internet in the world, today is considered as an independent knowledge and expertise. Definition of Digital Marketing The HubSpot site, which is considered to be a prestigious site in the field of digital marketing and content strategy, points out in the definition of digital marketing that it is a conceptual umbrella. In other words, instead of providing a straightforward definition of it, it’s best to know all the techniques and tools that are under the heading of digital marketing. 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Team-TDC Official Contents F1ドリーム平塚をホームコースとする、レンタルカートの耐久レースをメインに活動しているチームのコンテンツです。
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Medical write-up about normal Physical findings in English 11/07/00 Hisamatsu,M.D. カルテの記入は日本語で書くことが望ましいですが、身体所見の記載に関しては、英語のほうがより コンパクトにまとめられるのではと思います。正常所見の英語による記載方法例を作成してみました。 注）※の印は異常所見の書き方の例です。 身体所見=Physical examination 身体所見上異常認めず= Physical examination reveals(shows,discloses) no abnormalities. Physical examination are normal. Physical findings are normal. There are no abnormal findings on Physical examination VS=Vital Signs T36℃(36 degrees in Celsius or centigrade) , P88 , R14 , BP130/80(130 over 80と読む) General appearance Development（体格）,nourishment（栄養） well-developed, well-nourished, poorly developed,poorly nourished, fatty,obese,thin,lean Degree of illness be in distress, be acutely ill appear to be in no distress, appear severely ill appear to be in acute distress, appear to be in mild respiratory distress seem to be in distress Level of consciousness（意識レベル） normal, lethargy,somnolence,drowsy, stupor, coma, alert ,cooperative and oriented ×3 (oriented as to time,person,place) Emotional state（感情） look anxious, appear to be in depressed state 例） General appearance the pt is a well-developed, obese man. appears to be in no distress,but in depressed state. consciousness alert ,cooperative, and oriented×3 HEENT(Head Eyes Ears Nose Throat) Head Normocephalic and atraumatic or Normal in size and shape, No tenderness Eyes PERRLA(Pupil equal, round,reactive to light and accommodation) Visual acuity intact or Visual acuity is 1.2 on the right EOM intact bulbar (palpebral) conjunctiva not injected or congested, no icterus, no pallor Optic funds not visible（観察できず）, no abnormalities,no papilledema, exudate and bleeding Ears Hearing acuity intact or wnl (within normal limits) Tympanic membranes (Eardrums) clear with good light reflex Nose No discharge,symmetrical,septum midline,mucous membranes are not injected or congested patent (No obstruction) Sinuses No tenderness,discharge Mouth / Throat Teeth intact ,mucosa moist,gingiva normal Tongue moist,well-papillated,midline uvula midline, no injection,exudate of tonsil no tonsillar enlargement ※All teeth are absent (missing), oral hygiene is poor Neck supple (not stiff, no stiffness,no nuchal rigidity) trachea midline No thyromegaly (No enlargement of thyroid, Not increased in size), non-tender thyroid ,soft on palpation No lymphadenopathy (no enlargement of cervical lymph node,lymph node not palpable, not palpated) Carotid (artery) equal and normal upstroke and in size,no bruit Jugular vein is not distended ( Jugular venous pulsations are not visible, not distended, not elevated) ※JVP are distended (elevated) to a level of 5 cm above sternum angle at 45 degrees of elevation. Back No CVA tenderness, no deformity of the back and spine CVS(cardiovascular system) Regular rate rhythm (RRR),Non-dislocated PMI ,normal in size and intensity (PMI is visible and palpated in the 5th interspace at the LMCL (left midclavicular line) inside ... medial to ... ※outside ... ※lateral to ... ※IRIR(irregularly irregula rate rhythm) Diffuse PMI is shifted (dislocated) toward the left and felt (palpated) in the 6th interspace. S1 and S2 normal in intensity, normal split with inspiration No murmur,gallops,rubs (No GMR) ※S3 heard at the apex, Grade 2/6 pansystolic murmur at the apex with radiation to axilla or neck Lung Clear to auscultation and percussion (CTAP), No wheeze,rhonchi, rales(crackles) respiratory movement intact ,symmetrical diaphragmatic excursion 5 cm,symmetrical (diaphragm descended to 4cm) tactile (vocal) fremitus wnl ※dullness to percussion on the left side vocal fremitus decreased (increased) Abdomen the wall flat and soft, normal active bowel sound (NABS), no masses,bruits liver size normal by percussion in MCL (10 cm by percussion in MCL or percussed at 9 cm in MCL) normal liver edge spleen size normal by percussion , kidney not palpated ※the wall distended or scapohid(depressed) ー 腹部は膨満もしくは陥凹 Liver palpated 2 cm below the right costal margin Skin (integument) no clubbing ,cyanosis,edema (No CCE) Extremities No deformity Example PMH),FH) unremarkable Physical examination) VS T36℃ , P88 , R14 , BP130/80 General appearance the pt is a well-developed, obese man. appears to be in no distress,but in depressed state. Consciousness alert ,cooperative, and oriented×3 HEENT Head Normocephalic and atraumatic, no tenderness Eyes PERRLA,Visual acuity intact, EOM intact , bulbar and palpebral conjunctiva not injected or congested, no icterus, no pallor fundi no papilledema, exudate and bleeding Ears Hearing acuity wnl ,Tympanic membranes clear with good light reflex Nose No discharge,symmetrical,septum midline,mucous membranes are not injected ,patent Sinuses No tenderness,discharge Mouth / Throat Teeth intact ,mucosa moist,gingiva normal, Tongue moist,well-papillated,midline uvula midline, no injection,exudate of tonsil Neck supple ,trachea midline, No thyromegaly,No lymphadenopathy Carotid equal and normal upstroke and in size,no bruit, jugular venous pulsations are not elevated) Back No CVA tenderness, no deformity of the back and spine CVS RRR,Non-dislocated PMI ,normal in size and intensity S1 and S2 normal in intensity, normal split with inspiration, No murmur,gallops,rubs Lung Clear to auscultation and percussion , No wheeze,rhonchi, rales respiratory movement intact ,symmetrical, diaphragmatic excursion 5 cm,symmetrical , tactile and vocal fremitus wnl Abdomen the wall flat and soft, normal active bowel sound ,no masses,bruits liver size normal by percussion in MCL ,normal liver edge spleen size normal by percussion , kidney not palpated Skin (integument) no clubbing ,cyanosis,edema (No CCE) Extremities No deformity Pulse carotid brachial radial femoral popliteal post tibial dosalis pedis Rt + + + + + + + Lt + + + + + + +
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Wound Management nishitarumizu 2000.9.19 I. General Principles The goal of wound management is primarily restoration of function, which requires minimizing risk of infection and repair of injured tissue with a minimum of cosmetic deformity. Be sure to maintain universal precautions. II. Significant History A. Mechanism of injury. 1.Blunt trauma. Split or crush type of injuries will swell more and tend to have more devitalized tissue and a higher risk of infection. 2.Sharp trauma. Clean edges, low cellular injury, and risk of infection. 3.Puncture wounds. 4.Bite injury. B.Contaminants. Wound contact with manure, rust, dirt, etc., will increase risk of infection. Wounds sustained in barnyards or stables are considered contaminated. Clostridium tetani is indigenous in manure. C.Time of injury. After 3 hours, the bacterial count in a wound increases dramatically.Wounds may be closed primarily up to 12-18 hours out; clean well and use clinical judgment when choosing which wounds to close. Wounds up to 24 hours old on the face may be closed after good cleaning. The blood supply in this area is much better and the risk of infection therefore much less. The risk of infection may be reduced in wounds by use of tape closures (such as Steri-Strip tape). D.Tetanus status(http //homepages.go.com/homepages/a/n/e/anealkhan/tetanus_prophylaxis.htm) E.Other medical illnesses. Diabetes, chemotherapy, steroids, peripheral vascular disease, and malnutrition may delay wound healing and increase the risk of infection. III.Physical Exam A.Vascular injury. Direct pressure is the first choice for controlling bleeding. If a fracture is involved, immobilization will help control bleeding. Do not clamp vascular structures until it is determined if it is a significant vessel needing repair. If the anatomy is suspicious for injury to major vascular structures, obtain angiogram and consider surgical consult. Capillary refill should be checked distally. Bleeding on the scalp is best controlled by suturing of the wound. For extremities, inflating a blood pressure cuff above systolic pressure assists in wound inspection and repair. However, be careful not to cause ischemic injury to the extremity. B.Neurologic injury. Check distal muscle strength and sensation. Always check sensation before administering anesthesia. For hand and finger lacerations check 2-point discrimination, which should be less than 1 cm at the fingertips. A crush injury may also decrease 2-point discrimination. This may take several months to recover. A lacerated nerve may be repaired immediately or have repair delayed. Loss of sensation may be the first sign of a developing compartment syndrome. C.Tendons. Can be evaluated by inspection, but individual muscles must also be tested for full range of motion and full strength. D.Bones. Check for open fracture or associated fractures. X-ray if any question. An open fracture is an indication for surgical debridement and repair except in the case of a distal phalanx fracture where copious irrigation and oral antibiotics are acceptable treatment if the injury can be watched carefully for infection. E.Foreign bodies. Inspect and x-ray the area. Remember that wood or low-lead glass may not show on radiograph. Wound markers can be used during radiographing, and views obtained in two planes can help localize the object for recovery. Glass may penetrate at an angle and be buried deeper than it appears to be. Ultrasonography is very sensitive at picking up foreign bodies if radiograph is questionable or there is strong clinical suspicion. IV.Repair A.Wound healing. 1.Ephithelialization occurs in 24-48 hours under optimal conditions. 2.Collagen formation. Peaks at day 7. Wound has 15% to 20% of full strength at 3 weeks, 60% full strength at 4 months. The wound is then completely sealed. 3.Scar formation. Requires 6 to 12 months for a mature scar. The smallest scar will be formed when the wound is not under tension. Scars should not be revised until 12 months have passed. Contractures can develop when a scar intersects perpendicularly to a joint crease. B.Wound preparation. Hand washing, face masks are recommended. C.ANESTHESIA 1.In general, pain control should be provided before extensive wound preparation. 2.Local. Use 27- or 30-gauge needle and infiltrate slowly and through the open wound edge avoiding the intact skin. This decreases the pain of infiltration. The addition of bicarbonate to lidocaine before infiltration has been shown to significantly decrease the pain of injection (9 ml of lidocaine and 1 ml of bicarbonate) and warming lidocaine to body temperature may help as well. a.Lidocaine (0.5% to 2%) most frequently used with onset 2 to 5 minutes, duration 60 minutes. Can use 3 to 5 mg/kg with not more than 300 mg total (in adults). Avoid using lidocaine with epinephrine on distal extremities such as the ears, fingers, toes, and penis. b.Mepivacaine (Carbocaine) has onset 3 to 5 minutes, duration of 90 to 120 minutes. c.Bupivacaine (Marcaine) has onset 5 to 10 minutes, duration of hours; longest lasting of the local anesthetics. Intravenous administration may cause serious arrhythmias. d.For "caine" allergies, use diphenhydramine diluted to 1%. Mix 5% diphenhydramine 1 4 ml with normal saline to make a 1% solution. Onset of anesthesia takes longer and does not last so long as with lidocaine. Stronger solutions may cause tissue necrosis. 3. Regional anesthesia. Especially good for fingers, hands, feet, toes, mouth, and face. See Chapter 17 for common blocks. HEMOSTASIS Control of bleeding is necessary for both hemodynamic stability and for proper evaluation of a wound. Direct pressure, epinephrine, bipolar electrocautery, tourniquet. FOREIGN -BODY REMOVAL Avoid the temptation to initially explore wounds with a finger in search of foreign body. Plain radiography , US, CT HAIR REMOVAL Shaving the area with a razor damage the hair follicle, allowing bacterial invasion, and is associated with a ten fold increase in infection rate when compared with clipping. Hair should be as completely as possible with clipping 1to 2 mm above the skin with scissors. Never shave eyebrows because they are needed for alignment of the wound and may not grow back. IRRIGATION Irrigation pressures of 5 to 8 psi are recommended, which is achieved using a 19-guage needle with either 35-ml or 65-ml syringe. Fluid (saline) volume 60ml /cm of wound length. 200ml- 1000ml. There is no added benefit to the addition of an antiseptic ( such as povidone-iodine or hydrogen peroxide) . All detergents cause tissue and fibroblast toxicity. DEBRIDEMENT Not only removes foreign matters, bacteria, and devitalized tissue,but also creates a sharp wound edge that is easier to repair. Using aseptic technique, devitalized tissue should be removed; avoid taking healthy tissue. High-pressure irrigation is the most effective means of cleansing a wound. Scrubbing does not cleanse the wound as well and using any disinfectant in the wound damages healthy cells needed for healing. SKIN DISINFECTION Can be performed with povidone-iodine solution or chlorhexidine. Avoid getting these solutions in the wound because they impede wound healing. D.Wound closure. 1.Avoid primary closure of infected and inflamed wounds, dirty wounds, human and animal bites, neglected and severe crush wounds,and puncture wounds. 2.Tape closure (with Steri-Strips or others). Strips carry a lower risk of infection than suturing does and may be a consideration for higher-risk wounds. 3.Open wound care. Saline wet to dry dressings with gauze will keep the tissue moist and help debride, Gentle washing of the wound 2 to 3 times per day will remove bacterially contaminated secretions (showers are appropriate for this). Avoid iodine dressings because they damage healthy tissue and will slow granulation. When clean granulation tissue is apparent, secondary closure may be considered or can change to dry, sterile, packing material. 4.Suturing. Sutures are of two types (1)absorbable and (2)nonabsorbable. Precision-point cutting needles, and small-sized suture (5-0 or 6-0) should be chosen for skin when a cosmetic closure is important as on the face. Conventional cutting needle is used for routine skin closure. 4-0 or 3-0 nylon may be used on extremities. Noncutting needle should be used for subcutaneous tissue. Extensor tendons are slow healing and should have permanent suture of small size chosen (such as polypropylene). Depending on your practice situation, a surgical consultation should be considered. The majority of subcutaneous or dermal suturing may be performed with an intermediate-duration absorbable suture. However, some wounds require permanent sutures (such as stainless steel wires in sternotomy). 5.Staples. Can be used on the scalp and abdomen with good result. However, avoid use on face, hand, or other areas where structures such as tendons and nerves may become incorporated into the staples. 6.Dressings. Maintaining a moist environment for the first 24h-48 h facilitate healing. Dressing absorbs exudate, protect contamination, and prevention of premature removal. Consider antibiotic petroratum-based ointment on face and torso. Antibiotic ointment should be avoided on distal extremities for more than 24 to 48 hours because it may lead to maceration and delayed wound healing. Immobilize if motion of a joint is going to increase skin tension. Keep the wound for 24 hours, after which time most wounds do not require a dressing. 7.Antibiotics. There is no medical indication for using prophylactic antibiotics in routine, noncontaminated, skin wounds. a.Consider antibiotic use for patients prone to endocarditis, patients with hip prostheses, lymphedema, contaminated foot wound in diabetics, or others with peripheral vascular disease. b.See Chapter 1 for antibiotic choices for bite wounds. V.Follow-Up Care A.Risk of infection highest 24 to 48 hours, and so all wounds should be rechecked at 48h. B.Washing and Grooming Within 8 to 24h after closure, wounds in highly vascular areas can be washed. Other areas can be washed after 12- 24h without increased an adverse outcome. However, immersion or soaking should be avoided. C.General guidelines for suture removal. Face, 3 to 5 days with tape reinforcement after suture removal. Scalp, 7 to 10 days; trunk, 7 to 10 days; arms, 7 to 10 days; legs, 10 to 14 days; joints, dorsal surface, 14 days. Increase length for diabetics or steroid-dependent patients who may require several weeks to heal.
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Depression nishitarumizu 2000.9.1 Overview Lifetime risk 7% to 12% for men, 20% to 25% for women. As many as two-thirds of the people suffering from depression do not realize that they have a treatable illness and do not seek treatment. Clinical depression commonly occurs concurrently with other medical illnesses and worsens the prognosis for these illnesses. Tip-offs for depression in a primary care setting May include fatigue, somatic complaints (such as headache, backache, chest pain, dyspepsia, and limb pain), anxiety symptoms, depressed mood, or insomnia. Risk factors female (especially post partum), history of depressive illness in first-degree relatives, prior episodes of major depression, prior suicide attempts, age 40 years, medical comorbidity, decreased social support, stressful life events, and current substance or alcohol abuse. Symptoms can be divided into 1. Emotional. Dysphoria, irritability, anhedonia, withdrawal. 2. Cognitive. Self-criticism, sense of worthlessness or guilt, hopelessness, poor concentration, memory impairment, delusions or hallucinations. 3. Vegetative. Fatigue, decreased energy, insomnia, hypersomnia, anorexia, psychomotor retardation or agitation, impaired libido. Diagnosis Depression is often difficult to diagnose because it can manifest in many different forms. Depression is a holistic disorder, affecting body, feelings, thoughts and behaviors. In addition to Depressed mood or Anhedonia ( loss of interest or pleasure ), five or more of the following symptoms have been present during the same two week period ESCAP-GS E nergy decreased S leep disturbance (classically , early awakening ; or may sleep longer than usually) C oncentration disturbance A ppetite disturbance (increased or decreased; with or without weight loss) P sychomotor changes G uilt (self-deplication, feelings of worthlessness) S uicidal thinking Depressed mood is neither necessary nor sufficient for a diagnosis of depression. Barriers to diagnosis Patient Barriers Somatic Presentations Stigma Clinician barriers Pandora’s Box Normal feature At least 50% of depressed patients are either undetected or are not adequately treated by primary care providers. Evaluation History May use Beck Depression Scale , Zung Depression Scale, or Geriatric Depression Scale to screen for high-risk patients. If depressive symptoms are present, determine a. Time course and severity. b. Any prior episodes and level of recovery. c. Any history of manic or hypomanic episodes. d. If other major psychiatric disorders are present. e. Any suicidal ideation, plan, or intent. Examination Evaluate for possible related medical conditions anemia, hypothyroidism, chronic infection, substance abuse, or medication side effects (oral contraceptives,antihypertensives, etc.). Causes of organic depressions Type Specific Cause Drugs corticosteroids,contraceptives,reserpine, antibiotics alpha-methyldopa,anticholinestherase, cimetidine ranitidine, indomethacin, phenothiazines, thallium mercury, cyclosporine, vincristine, vinblastine Drug withdrawal amphetamine, cocaine Infection Tertiary syphillis, influenza, AIDS, viral pneumoniae Viral hepatitis, infectious mononucleosis, Tb Endocrine Hypothyroidism, apathetic hyperthyroidism, Hyperparathyroidism, postpartum and menses-related, Cushing’s disease, adrenal insufficiency Collagen SLE, RA, vasculitis Neurologic MS, Parkinson’s disease, head trauma Complex partial seizures, CNS tumors, stroke, Early dementia, sleep apnea Nutritional Vitamine deficiencies (B12, C, folate, niacin, thiamine) Neoplastic Pancreatic cancer, disseminated carccinomatosis Others Renal Failure,Liver Failure, Alcohol/Substance Abuse Lab tests Screen for medical causes of depression (if suspected by Hx or Pex) Complete blood count (CBC) Electrolytes, including calcium, phosphate, magnesium BUN and Creatinine Calcium Serum toxicology screen TSH level CT or MRI of brain Electrocardiogram (ECG), Electroencephalogram (EEG) Physical Psychomotor retardation or agitation, such as slowed speech, sighs, and long pauses Slowed body movements, even to the extent of motionlessness or catatonia Pacing, handwringing and pulling on hair Preoccupation Lack of eye contact Tearfulness Self-deprecatory manner Memory loss, poor concentration and poor abstract reasoning Consultations Psychiatry should be consulted after a screening evaluation is complete and all acute medical complications are addressed. Treatment Treatment is effective in at least 70% of cases. Communicating with depressed patients Empathy Presenting the diagnosis “These symptoms indicate to me that you are suffering from depression.” It can be helpful to then add a couple of additional symptoms not mentioned by the patient. It is helpful to explain depression as a common biological disorder. Drawing a picture of a synapse and neurotransmitters may be helpful. Depression is a curable illness. Counseling by the physician SPEAK approach Schedule Pleasurable activities Exercise Assertiveness Kind thoughts about onself Psychotherapy cognitive therapy behavioral therapy Medication Most antidepressants believed to be equally effective in equivalent therapeutic doses. Expect a 2- to 6- week latent period before the full effect is seen at therapeutic doses. To prevent relapse, continue medication for at least 4 to 9 months after patient becomes asymptomatic. For recurrent depression, consider chronic prophylactic therapy. If at 6 weeks a patient shows no response or a poor response to an adequate dose of antidepressant medication , treatment should be changed. Tricyclic antidepressants (TCAs). Choose between them based on patient s sedation requirements and ability to tolerate orthostatic hypotension, weight gain, and anticholinergic adverse effects TCAs are usually given QHS to take advantage of sedating effects. All TCAs may cause slowing of cardiac conduction. May be fatal in overdoses around 2000 mg or more in adults. A therapeutic trial usually is considered 100 mg/day of amitriptyline or its equivalent for at least 3 weeks. Note Nortriptyline (Pamelor) has a "therapeutic window" plasma level of 50 to 150 ng/ml for optimal efficacy. It has the lowest risk for orthostatic hypotension of all TCAs making it a safe choice in the geriatric patient. Selective serotonin reuptake inhibitors (SSRIs) Much safer in overdose than TCAs. Expensive in contrast to generic TCAs. Initial dose often an effective dose. May need to start at lower doses in the elderly of others sensitive to side effects. Side effects vary and may include nausea, anorexia, insomnia or mild sedation, sweating, headache, tremor, sexual dysfunction, and nervousness. Fluvoxamine is contraindicated with astemizole and terfenadine. All SSRIs contraindicated with MAOIs. If switching from a SSRI to a MAOI, need a drug-free period of 14 days for paroxetine, sertraline or fluvoxamine or 5 weeks for fluoxetine. Monoamine oxidase inhibitors (MAOIs) Sometimes used in depression refractory to the other treatments. Consider consulting psychiatrist before starting because of the serious adverse effect potential. St. John’s wort For short-term treatment of mild acute depression. Equally effective. Induction of the cytochrome P450 system. Psychostimulants Methylphenidate(Ritalin) They take effect very quickly( 24h) Provide a relatively quick test of whether antidepressants are likely to be effective. Electroconvulsive therapy. ECT is the most effective, rapid method of treating severe major depressive disorder (MDD). Indicated for patients with poor response to medications, poor tolerance of usual antidepressants, severe vegetative symptoms, or psychotic features. The decision to administer ECT should be made by a psychiatrist. Figure. Adverse effects of selective serotonin reuptake inhibitors (striped bars) and tricyclic antidepressants (white bars). REFERENCE Pharmacologic Treatment of Acute Major Depression and Dysthymia Ann Intern Med. 2000; 132 738-742 Behavioral Medicine in Primary Care A Practical Guide 1st.ed. Assessing and Managing Depression in the Terminally ill Patients. Ann Intern Med. 2000; 132 209-218 http //www.wellbutrin-sr.com/eval/zung.htm http //www.vh.org/Providers/ClinRef/FPHandbook/Chapter15/01-15.html#Box%2015-1 http //www.emedicine.com/emerg/index.shtml
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ISSClock2 Documents STUB!! ; 書きかけです＞＜； Version "Disposable(Capsule)" because the configuration file attachments will be read automatically, Available only to launch without having to configure anything. If you change the setting does not save. How To Use for Disposable(Capsule) Version 使い捨て版(カプセル版)を打ち上げの時に見るだけなら ダブルクリックで起動するだけでOKです 使い捨て版用の説明書 Quick Start Step 1 Install インストール方法 Step 2 Open a sample file おまけの設定ファイルを読み込む Configuration 設定とか Timer Events タイマーの設定とか under construction. I m sorry. まだ書いてない。ごめんなさい＞＜； View Options 表示 OverlayWindow 半透明合成表示 Was implementation by LayeredWindow API. (http //msdn.microsoft.com/en-us/library/ms997507.aspx) コメント バグ関連はこちらのページのコメント欄にお願いします m(__)m 名前 コメント トップページ
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移転しますたー！ mph team ki 君は、今日 - 人目のサイラックヌ 昨日は - 人サイラックヌがおとずれた。 RKとは RKとはcoaが作成したチームです。入隊規約を守れるのであれば誰でも入隊OKです。意味も分からないガキはここからさっさと出て行ってください！。ここの事を理解していて、入隊したい人は入隊BBSに書き込みをしてください♪。 お知らせ 予定 なんと、副リーダーがいました！なので、その優しい目で見守ってくださいw メンバー表 リーダー リーダー coa 20090706213108.png ランク★★★★ 名前 coa fc 4470-0763-9181 コメント 復活しました！ 副リーダー 副リーダー @meteo@ 1cda.jpeg?mgw16BOB5WMLwEl8 @meteo@ ランク★★ fcは今度追加する予定。 コメント 弱いですが、見守ってください。 メンバー カイザー link.jpg カイザー ランク★★★ fc4040-3987-9554 コメント 強くも弱くもないカイザーです！。宜しく。 コンバえらんで！ コンバえらんで！ ランク★★★★ fc0432-8644-8535 コメント 宜しく！ 入隊規約 改造、バグ、切断、馴れ合いは、ランダムで使っていたら、入隊できません。部屋でのバグ、馴れ合いは許可させてもらいます。(^∀^)¥ 入隊したら、名前にRKと付けてください。ランダムに行くときは外してください。外していなかったら、フルボッコにするかもしれません。ここには気おつけてください。改造に会ったら、時間の無駄ですので、切断を許可させてもらいます。 チームの掛け持ちは、禁止します。どうしてもと言うなら、掛け持ちokにします。 入隊希望はお早めに！ これからもいろいろな活動していきますんで、これから宜しくお願いします。 入隊BBS 入隊希望の方は、名前とFCとコメントを書いて書き込みして下さい 名前 コメント 荒し禁止 リンク チームMETO ミクルさん率いるチーム チーム7F Vol(T)さん率いるチーム チームPZ ぴぽさん率いるチーム チームast キルスラさん率いるチーム メンバー専用BBS BBS どんどん書き込みしていってね。 -- セシル (0000-00-00 00 00 00) かっこよくなった -- セシル (2011-07-28 22 28 09) フィリップちゃんいる？ -- カメレオン (2011-07-30 09 51 28) セシルさん、見に来ました！ -- HTの新入りケミカル (2011-07-30 09 52 31) カメレオンちゃんと、ケミカル君！こんにちはー -- セシル (2011-07-30 17 19 52) リンクにサイトを追加してほしいときは、ここに書き込んでください。 -- セシル (2011-07-30 23 13 57) セシルさん、バイオさん、そしてHTの皆様にも先程の試合についてここで謝罪させていただきます。またしても無礼な戦い方、あわせ無視、謝罪の態度の悪さ本当にすみませんでした！もし次にも相手してくださるならその時こそは気持ちの良い戦い方をします。 -- ケミカル (2011-08-01 16 56 58) ケミカルくん、そのくらい反省するなら、okです！！！ -- セシルーるいじこあ (2011-08-02 21 16 59) 初めましてHTの副リーダー代理のブリザドです これからもHTを宜しくお願いします -- ブリザド (2011-08-07 09 28 01) メンバーに追加してほしかったら、メトハンで、色々教えて。 -- コア (2011-08-14 18 34 36) コアリターンズ！！！！！！ -- 伝説 (2011-08-16 14 56 42) あら? こここあのチーム?ｗ -- ブリザド (2011-08-18 11 10 16) 俺のチームだけど？w -- coa (2011-08-18 16 16 49) ほう チーム作ったんだｗ -- ブリザド (2011-08-18 17 44 03) クチコミとかでサイト作れんw -- coa (2011-08-18 20 18 40) 何故ｗ -- ブリザド (2011-08-19 11 17 51) ブリザドさんにフレ希w -- coa (2011-08-19 11 55 11) ふむ 何故にさん付けなのかは分からんがｗ 良いでしょう（ 3439 3531 1061 -- ブリザド (2011-08-19 16 34 21) fffffcCcc 4470-0763-9181 -- coa (2011-08-19 16 49 36) まてまて 紛らわしくなってきた ここのこあってフィリップ?ｗ -- ブリザド (2011-08-19 18 14 24) どうも、V2の真紅です。もしかして、元HTのcoaさんでしょうか？ｗ -- 真紅⊂V2 (2011-08-19 19 41 49) 悟りちゃん 違うらしい 帰ろうかｗ -- ブリザド (2011-08-19 23 47 29) 一番下に 占いゲーム を追加した。完成日は不明。 -- coa (2011-08-20 16 21 10) 名前 コメント メトハンをやる約束などをしましょう。荒しは禁止です。 晒しBSS シルバー ショッコ厨.逃げ.体力無制限. モーフ厨。こいつに会ったら切断することを許可する。 -- seshil (2011-07-28 18 38 21) 名前 コメント YouTubeリーダーお気に入り動画 戦うと言う素晴らしさを書き込もう 戦うと言う事をこよなく愛してる人は書き込もう。 -- SESHILU (2011-07-27 09 23 43) 名前 コメント o036303621296738385188.jpg 現実広場 皆様の節電に関するご意見をお聞かせください。 名前 コメント 占いゲーム