Introduction: We report a case of severe headache caused by lung cancer metastasis to the base of the skull that was difficult to diagnose due to a lack of imaging evidence. Case: A 70-year-old man diagnosed with advanced lung cancer experienced sudden, severe headache. He was diagnosed as having a tension-type headache because magnetic resonance imaging of his head failed to detect any pathology. He was prescribed various drugs, which except for strong opioids failed to treat his headache. He referred to our palliative care unit to treat the pain. Re-evaluation of his head CT revealed metastasis to the clivas. His pain was treated with rapid titration of subcutaneous oxycodone injection. Conclusion: Even if radiographic investigations fail to identify the metastasis, the patient should be re-evaluated if the headache worsens and/or is accompanied with cranial nerve dysfunction.

This study clarified practices in end-of-life care for non-malignant chronic illness patients by expert nurses in general hospitals. Interviews with 7 chronic illness specialist nurses on practice cases were conducted, and final labels were elicited using a qualitative synthesis method（KJ method）. As patients’ conditions deteriorated, nurses defined the necessary interactions to support patients’ decision-making for living their own way of life and accompany patients and families based on their experience, and using patients’ restoration of self-esteem, sense of satisfaction, and acceptance as indices. In general hospitals, measures to cope with pain for patients not receiving life-prolonging treatment were insufficient;and while it was difficult to agree on care between medical professionals and to maintain care in other facilities, expert nurses grasped patients’ wishes on a daily basis and made arrangements for them to permeate through family and community care systems. In end-of-life care in treatment settings, it is necessary to be supportive so that the family and medical professionals can continue the patient’s care. Medical professionals who have been involved from the initial diagnosis stage need to improve their awareness and support skills as medical professionals to be involved purposefully from an early stage to the final stage.

It is essential to prolong the term as possible in the treatment of threatened premature delivery. We report a case of threatened abortion successfully treated with hochuekkito. The patient was 31 year-old pregnant woman with lower abdominal pain. She was diagnosed to be at the risk of premature delivery on 21 weeks and 5 days of gestation. Intravenous ritodrine hydrochloride was started and she had to stay in bed. Severe side effects of ritodrine hydrochloride such as palpitation, tachycardia, tremor, nausea, and loss of appetite were appeared and she was consulted to our department on 23 weeks and 1 day of gestation. Those symptoms were markedly improved after administration of hochuekkito extract. She delivered a male infant of 1230g birth weight on 28 weeks of gestation. Hochuekkito suppressed severe side effects, and enabled to continue the infusion of ritodrine hydrochloride, suggesting the usefulness of Kampo therapy in the treatment of threatened premature delivery.

Purpose: The human papillomavirus (HPV) vaccine is safe and effective for preventing HPV-related diseases. However, HPV vaccination rates in Japan are low because the “Ministry of Health, Labour and Welfare” had stopped recommending vaccination. We assessed healthcare workers’ (HCWs) current recommendations regarding the HPV vaccine and how the provision of information about HPV vaccination affected their recommendations. Materials and Methods: A survey was conducted among nurses and physicians in Nara prefecture from March 2021 to July 2021. The questionnaire asked about their understanding, recommendations, and opinions regarding HPV vaccination. Before answering the last two questions (optional), the HCWs read evidence-based information quantifying the risks and benefits of HPV vaccination. Results: A total of 441 HCWs completed the questionnaire. Only 19% of HCWs always recommended HPV vaccination for girls aged 12–16 years. The evidence-based information significantly improved the percentage of HCWs who would “always recommend” vaccination. Conclusion This study showed that the proportion of HCWs who recommend HPV vaccination to adolescent girls remains low in Japan. However, we found that evidence-based information describing the causal relationship between adverse events and vaccination, quantifying the risks and benefits, noting the importance of HCW communications with families, and reporting the recommendations of national societies, might increase HCWs’ recommendations for HPV vaccination.

　　In recent years, favorable therapeutic outcomes have been reported for arterial injection chemoradiotherapy for tongue cancer. The present case involves an 80-year-old woman in our palliative care department who had high-grade, advanced tongue cancer. Because there was a request for surgery to prevent airway occlusion due to growth of the tumor, she was referred to our department in April 2009. As a treatment policy for controlling tumor growth in high-grade, advanced tongue cancer, arterial injection chemoradiotherapy was carried out through the superficial temporal artery, with a tongue artery catheter in place on both sides. Therapeutic effect was obtained, and it was possible to avoid airway occlusion through tumor regression. Dysphagia and dysphemia were improved, which in turn improved quality of life. In this case, there was an opportunity to carry out multidisciplinary team medicine, including support from the oral care and palliative care teams as part of the process of cancer therapy. Here, we present our findings in this case.

Usually, chronic pain is difficult to treat because this is often accompanied by none-organic factors such as psychiatric symptoms, which complicate the pathological condition. For this reason, the guidelines also call for coping with peripheral symptoms except pain. This time, we report that facial pain as well as peripheral symptoms such as mental anxiety gradually improved by a combination of decoction extract and acupuncture and moxibustion. The case was a man in his 60s, who received all kinds of treatments such as taking Western medicines and blocking trigger points for chronic facial pain of unknown cause with mental anxiety. However, even after one year the side effects were strong and the treatment was ineffective. Acupuncturists and Kampo specialists made the diagnosis and treatment based on a common concept of Kampo medicine. Treatment focused on shin abnormalities and oketsu suppressed the vicious cycle of pain and improved psychiatric symptoms and QOL. It was suggested that Kampo medicine based on the idea “the same in mind and body” is effective for chronic pain in which various symptoms are intricately intertwined.

To improve the quality of palliative care in the Kyoto region, we thought that closely connecting hospice and palliative care units (PCU) is necessary. Subsequently, we established the Kyoto PCU Liaison Committee in September 2017. This committee was created as a place to casually discuss the problems that individual PCU facilities have, deliberate on their worries together, grow and develop, and support newly launched facilities. Furthermore, discussions were held on current topics (emergency hospitalization, blood transfusion, smoking, bereaved family meetings, etc.) at the liaison meetings. While meetings were adjourned in 2020 due to the COVID-19 pandemic, we continued to exchange opinions on infection control, PCU management, etc., using the email network at first. Later, these meetings resumed via web conference systems. Thus, by having face-to-face relationships on a daily basis, we were able to maintain cooperation between PCUs even during the pandemic, and collaborate with cancer treatment hospitals. Overall, by forming a team of PCUs in Kyoto Prefecture, we aim to enable patients and their families to live with peace of mind wherever they are.