To clarify characteristics of home care in rural areas in Japan, we investigated the actual status of home care in a rural area (Asuke town, Asahi town, Inabu town, northern part of Toyota city and Shimoyama village) in Aichi prefecture. The subjects were 149 patients who were under medical care and nursing supervision at home for the last 2 years and a half. Age, sex, ADL, prognosis, principal care-givers of the patients and distance from patients' houses to our hospital were compared with the average data of all the nurse stations in Japan (1996). The percentage of patients over 90 years old was 23.4% in this area as against 13.5% of the national average. Sex and ADL levels were similar to the average. The proportion of females as principal care-givers of patients was 80%, which is about average. However, the proportion ofdaughters-in-law was 51.7%, double of the national average. In 48 cases (32%), the time required to get to the hospital by car was over 31 min. This ratio was 3 times higher than that of the average data, and it took 50 min from farthest patient's house (35km). In prognosis, 66 patients died-44 cases (67%) in hospital and 22 cases (23%) at home.
Our questionnaire survey regarding patients' and care-givers' wishes was responded to by 38 of 47 principal care-givers who utilized our home care and nursing survice program. One half of care-givers were over 60 yearsold and had taken care of a patient for over 5 years. Mental stress, feeding and toileting were major problems most principal care-givers cited. However, they required services at a day-care institution for elderly patients and recovery of used paper diapers. Death at home was wished by 23 (61%) patients and care-givers, if they received enough medial care and welfare services.
These findings revealed that elderly people take care of elderly patients, their houses are far from the hospital and they wish to die at home. More collaboration among all providers of medical care and health and welfare services, and the establishment of an information network are necessary to improve these problems, resulting in safe, acceptable and satisfied home care for patients and care-givers.

The first step of cancer medical treatment is to eliminate anxiety about opioids. It is recommended to use printed matter in the "Guideline for Cancer Pain Management" edited by Japanese Society of Palliative Medicine,but few medical professionals actually use it. We developed the Opioids' pamphlet designed by Aichi Prefectural Society of Hospital Pharmacists; abbreviated OPA. This pamphlet is little burdened for readers; focusing on eliminating anxiety about opioids. Evaluation of the utility of the OPA and the actual conditions of patient education about the use of opioids by medical professionals were investigated, since there have been no reports on these issues. A questionnaire survey was conducted in hospitals with more than 150 beds in Aichi Prefecture. It targeted doctors, pharmacists and nurses who were practicing palliative care using opioids. There were many pharmacists and nurses who had been consulted about opioids, and most of the consultations were about addiction. 60% of pharmacists and 30% of nurses voluntarily performed patient education. Awareness of the guideline for of cancer pain management was low. OPA, which was reviewed based on the guideline, was applicable to 99% of the cases where the nurses were consulted. Its size and contents were highly acclaimed. Therefore, OPA is extremely valuable in clinical practice. Palliat Care Res 2009; 4(1): 214-227

OBJECTIVE: This study was conducted to examine the effects of front-line chemotherapy on overall survival (OS) and postrecurrence survival (PRS) of patients with recurrent ovarian cancer, when stratifying the histologic type. METHODS: Five hundred and seventy-four patients with recurrent ovarian cancer with sufficient clinical information, including front-line chemotherapy, were analyzed. The pathologic slides were evaluated by central pathologic review. The patients were divided into two groups: group A (n=261), who underwent taxane plus platinum, and group B (n=313), who underwent conventional platinum-based chemotherapy without taxanes. RESULTS: The median age was 54 years (range, 14 to 89 years). Group A had significantly better median OS (45.0 months vs. 30.3 months, p<0.001) and PRS (23.0 months vs. 13.0 months, p<0.001) compared to group B. The OS and PRS were similar between the groups in patients with clear cell or mucinous histology. In contrast, among patients with non-clear cell, non-mucinous histologies, the OS and PRS of group A were significantly better than those of group B (OS, p<0.001; PRS, p<0.001). Multivariable analyses revealed that, among patients with non-clear cell, non-mucinous histologies, chemotherapy including taxane and platinum was an independent predictor of favorable survival outcomes. Conversely, in patients with clear cell or mucinous histology, taxane-including platinum-based combination chemotherapy did not improve the OS and PRS compared to a conventional platinum-based regimen which did not include taxanes. CONCLUSION: Since the emergence of taxane plus platinum, the prognosis of patients with recurrent ovarian cancer has improved. However, we here demonstrate that this improvement is limited to patients with non-clear cell, non-mucinous histologies.
Drug Therapy ; Drug Therapy, Combination ; Humans ; Mucins ; Ovarian Neoplasms* ; Platinum* ; Prognosis ; Taxoids

From January 1981 through December 1986, 27, 513 individuals consisting of 17, 918 males and 9, 595 females underwent health examinations at Health Care Center in Obihiro Kosei Hospital. 14.2% of healthy and asymptomatic men and 29.1% of healthy and asymptomatic women had microscopic hematuria (one or more RBCs per HPF).
To evaluate the clinical significance of microhematuria, about one third of patients with asymptomatic microhematuria who had undergone complete urological examination were reviewed.
Genitourinary neoplasms were found in 0.21%(8 bladder cancers, 2 prostatic cancers and 1 renal cell cancer). The incidence of cancers increases proportionate to increase in age, furthermore, lesions were found more commonly in men than in women. We could find no relationship between the degree of hematuria and the cause. The results suggest that patients with asymptomatic microhematuria should undergo urological examinations.

At Anjo Kosei Hospital, all staff has been working concertedly on a project to establish a community hospital in line with our future vision. Hospital staff in charge of the Medical Affairs Division has been involved in measures aimed at achieving the slogan “health and happiness of local residents” as part of this project. To address this, three goals were set as follows: improvement of recoveries in accounts receivable management, a reduction of money held in trust, and a decrease in the number of outsourced transactions. To achieve the goals described above, the following specific measure were carried out: (1) collection of accounts receivable using convenience store settlement; (2) collection of high-cost medical expenses by wider use of Eligibility Certificates for Ceiling-Amount Applications and promotion of the Major Medical Cost Loan System for national health insurance holders; and (3) support in acquiring family registration for nonregistered family members and for health insurance benefits. Recoveries of accounts receivable through convenience store settlement was about 90,000 yen/month, and our support activities for family registration and health insurance benefits provided the recoveries of about 80,000 yen/month. Furthermore, the promoted use of the certificate and loan system resulted in recoveries of about 17 million yen/year. The average commission fee and number of outsourcing was 890,188 yen and 12 cases, respectively, from April to August 2016. However, in 2017, it was 305,615 yen and 10 cases, respectively. Our project aimed at achieving slogan-elicited patient voluntary payment of medical expenses, leading to improved recoveries, with reduced money held in trust and fewer outsourced transactions.