1)Training elderly simulated patients (SPs) will enhance elderly persons' contribution to education. Such training will also help universities contribute to the community and help elderly persons be more productive in their activities.
2)Training programs for elderly SPs and follow–up seminars focusing on the display of symptoms requested by participants were held. The aim of this program was to train SPs to participate in the preclinical educational activities of the university. The participants evaluated the program to be satisfactory.

1) This study involved an educational evaluation of preclinical practice with simulated patients (SPs) by students in the departments of nursing, physiotherapy, and occupational therapy. The scores were highly correlated with the usefulness of SPs, the conviction and the realism of the performances of SPs, and feedback from SPs. Students required SPs to accurately mimic symptoms and to give them critical feedback. Follow-up sessions are required regarding performance as SPs.
2) Preclinical practice with SPs helped students grasp the reality of practice, enhance preparations, and help them recognize their role as professionals based on feedbacks from SPs.

A 47-year-old man underwent a double-valve replacement involving aortic valve replacement (AVR) and mitral valve replacement (MVR) and Re-Re-DVR 6 and 8 months, respectively, after an initial DVR because of suspected prosthetic valve endocarditis. Detachment of the prosthetic mitral valve occurred during the early postoperative period, for which the patient again underwent treatment 15 and 21 months after the initial surgery. The operative findings showed that the detachment was caused by a wide cleavage of the aortic-mitral continuity. There were bacteria detected on a blood culture, and his C-reactive protein (CRP) level did not reduce at any time. On the basis of these findings, we suspected nonrheumatic inflammatory disease and started steroid therapy. His CRP level became negative, and further prosthetic mitral valve detachment did not recur.