Our hospital is the only general hospital in Akitakata City, Hiroshima Prefecture. It plays an important role as a core hospital in enhanceing the quality of medical care, welfare, and health care in this region. With the advent of the super-aging society, the needs of aged patients are complicated and diverse. Accordingly, the problems and needs of patients have become difficult to cope with by medical treatment alone. To cope with the current situation, in April 2010, we established the Department of Outpatient Nursing Care, which is managed by nurses certified as palliative care and dementia care specialists, aiming to support medical treatment and lives for patients. The Department of Outpatient Palliative Care specializes in caring for patients with diseases such as cancer as well as their families, and the Department of Outpatient Memory Care specializes in caring for dementia patients and their families. These departments intend to provide not only medical treatment to people in our community but also support patients so as to enable them to spend the rest of their lives in peace. Here, we report our nursing care activities.

We four medical students (one in the 2nd year and three in the 3rd year) visited Thomas Jefferson University in Philadelphia for 2 weeks during spring vacation. We audited classes to study differences in medical education and visited the hospital to observe common medical practices in the United States. Because of this experience, we started to rethink medical care in Japan as well as our future commitment to medicine.

To examine the relationship between sports activity and bone mass acquisition, we observed one-year changes in the bone mineral content and density (BMC and BMD) of weight-bearing and non-weight-bearing bone in 68 college women who had participated in various sports since the age of 18.5 years on average. Based on their sports experience, the subjects were divided into four groups: Group A: 18 students who have not had participated in any kind of sports activity since junior high school days ; Group B: 8 students who had participated in team sports at junior and senior high school, then stopped practicing after entering college ; Group C: 14 students who had participated in team sports since junior high school ; Group D: 28 rhythmic sports gymnasts. Whole-body and regional BMC in the head, trunk, arms and legs, and BMD of the lumbar spine and proximal femur were measured using an XR-26 DXA scanner. Height, weight and calcium intake were similar among the four groups, and during the experiment their values changed little. With regard to annual changes in BMC and BMD for weight-bearing regions: 1) In Group A, no signifi-cant increases were observed in any of the body regions; 2) In Groups B and C, only the lumbar spine showed a significant increase. Comparing the changes in BMD in these two groups, Group C showed a larger increase than Group B, although the value did not reach statistical significance ; 3) In Group D, significant increases in BMD for the lumbar spine and femoral neck and in BMC for the trunk and legs were found. The annual changes in BMD were significantly higher than Group A. As to annual changes in non-weight-bearing bones such as those in the head and arms, there were not significant differences among the groups. These data indicate that sports practice may affect changes in bone mass in weight-bearing regions in female college students. Furthermore, it is possible that the amount and quality of sports training may influence the peak bone mass and its timing.

The Medical Education Development Center has organized seminars and workshops for medical education 30 times from 2000 through 2008 throughout Japan. The participants have numbered more than 3200 and have included educators, physicians, students, and simulated patients. The topics of seminars and workshops have included problem-based learning tutorial systems, medical interview skills, objective structured clinical examinations, evidence-based medicine, coaching technology, simulations, and community medicine in response to educational needs. A questionnaire survey of 1793 participants of the 11th to 30th seminars and workshops (response rate, 85.6%) showed a high degree of satisfaction (4.33±0.13 of 5 points). Invited lecturers and directors from throughout the country often organized these workshops. The results of workshops are reported in our annual monograph, "Trends in Medical Education."

Based on the assessment of the home health care services provided by our hospital over the past five years and the results of a survey of the people concerned, we studied the problems of home care and dwelt on what it should be in the future. An alarming fact was brought to light: Many of those who look after patients in their homes are stress-ridden. Even among those who said they are satisfied with the present care system, not a few expressed uncertainty about the future. Many were of the opinion that without option of putting the patients in hospitals or nursing homes if need be, the home health care system would not hold water.
Our hospital admits only those patients who are badly in need of hospital treatment, and technically many cases cannot be referred to general practitioners. To add to the development of home health care, it is necessary to establish a coll aborative system between hospitals and neighborhood clinics. Under the system, patients will be screened according to the degree of their need for medical care, and visiting nurses will be able to show their skill fully and provide care confidently while keeping close contact with physicians.

A correction of a coauthor's name from Chigusa Nakamura to Chigusa Nakagawa on the author list and the abstract.

Medical therapies, adapted to local requirements, are necessary in the field of community medicine. Generalized medical treatment is often all there is in Japan's Konsen Area, due to the large number of elderly people and a paucity of medical institutions. Kampo medical treatment is useful for elderly patients with plural diseases, and the demand for such treatment has been increasing. Therefore, we collected data on Kampo prescriptions prescribed by the doctors at the Nakashibetsu Municipal Hospital, which is the main local hospital in the Konsen Area, from 2010 to 2013. We conducted similar investigations at the Kushiro Red Cross Hospital in Kushiro city, which is centrally located in the Konsen Area, and at Asahikawa Medical University Hospital in Asahikawa, central Hokkaido. The aim of these investigations was to compare Kampo medicine use based on hospital location and size. The results can be used in community medicine to enhance the use of Kampo medicine with increase for its demand. Medical students and doctors should be educated in Kampo medicines, since their prescriptions have a significant impact on community health.

Purpose: From shortly after the fentanyl patch became commercially available, we have been using it as part of our armamentarium for cancer therapy to produce a reliable analgesic effect from the active treatment period to the terminal stage in patients who are expected to develop resistance to oral analgesics. To confirm the usefulness of fentanyl patch, a retrospective study was conducted to determine its efficacy and safety. Method: A survey was conducted of 28 cancer patients who were undergoing pharmacological pain control. The following parameters were recorded: opioids administered prior to fentanyl patch use, reasons for switching to fentanyl patch, duration of administration and dosage of fentanyl patch, pain score before switching to fentanyl patch, adverse effects (nausea, vomiting, constipation and drowsiness), and the results of clinical tests. Results: The major reasons for switching to fentanyl patch were: "pain control with oral agents was expected to become difficult in future" and "adverse effects of chemotherapy were noted or were likely to develop". The mean duration of fentanyl patch use was 133 days, during which time the pain score and the constipation symptom were significantly reduced. No significant difference was found with nausea, vomiting, drowsiness or the results of clinical tests. Conclusion: It is concluded that fentanyl patch is a highly useful opioid for analgesia when administered during chemotherapy for cancer and continued to the terminal stage.

This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

High-quality terminal care cannot be given without good communication and understanding among patients, their family members and health as well as medical professionals.Recently, we have taken a questionnaire survey on new inpatients in our hospital to sound them out on their thinkings about hospital care, and examined the findings along with the validity of survey.Many respondents including those contracting either benign or malignant diseases wished to be keptposted on what they are really up against and to partake in the decision-making process before treatment plans are put into practice. The recent questionnaire survey has proved to be worthwhile as a tool to know the wishes of hospitalized patients and suggested an effective way to promote the practice of obtaining informed consent before specific test and therapautic procedure.