Objective: The purposes of this study are to explore current status and tasks of a pamphlet for families of terminally ill patients at home. Methods: We sent out the questionnaire to 419 home-visit nursing administrators, and obtained an answer from 118. Results: About 42% administrators used the pamphlet. Most pamphlet users were considering as follow: degree of worry and anxiety of the family, the family’s and the patient’s hope of being home death (each more than 82.6%). Usefulness of the pamphlet; the families could prepare for their patient’s death, understand the present condition of the patient, etc. However, 67% users were feeling difficulty to decide the timing to hand the pamphlet to the families. As a reason without the pamphlet, there are not any pamphlets available (64.1%). Conclusion: Nursing administrators who used the pamphlet have recognized the usefulness, but have felt difficulty of the use.

With innovations of “Courses of Study” in high school, the number of medical students who have not studied biology has increased rapidly and has created problems for medical education. Therefore, we started a course entitled “Science for a Healthy Life” for medical school freshmen. In traditional lectures, students often lose interest and start talking among themselves. For these reasons, we introduced new interactive education techniques into lectures for “Science for a Healthy Life.” Most students were interested in the visual aids and the performance of simple experiments. The students could discuss subjects and present results. With these new educational techniques, most student learned actively and efficiently. Many students learned by themselves with visual aids and reference books outside class, for example, after school and during summer and winter vacation. Finally, we found no significant difference in examination results for “Science for a Healthy Life” between students who had studied biology in high school or those who had not.

A 65-year-old woman had left should pain for two months. She felt moderate pain in the left shoulder and she could not raise her left hand. She was diagnosed with shoulder periarthritis by an orthopedist, but her pain had not improved with medication and rehabilitation. So she came to our hospital. She had left shoulder pain with arthrogryposis and muscle atrophy over the course of the next two months. She had a floating and relaxed pulse with spontaneous sweating, so she was diagnosed with greater yang wind strike per Kampo medicine. Her left shoulder pain was improved with keishito for two weeks, and three months later she could raise her left hand. Greater Yang is characterized by floating pulse, headache, pain in the nape of the neck, chills, fever, general pain, and joint pain. And Greater Yang Wind Strike is characterized by fever, spontaneous sweating, mild chill and relaxed pulse. Keishito is useful for in Greater Yang Wind Strike, and our patient improved with keishito. However, keishito is generally used for the early stage of a common cold, and there have been a few reports that keishito is effective for chronic disease. To our knowledge, this is the first report of keishito being effective for shoulder periarthritis, and we believe that keishito is a valid option for the treatment of chronic pain in Greater Yang Wind Strike.

Benzodiazepines are frequently used for the treatment of insomnia, although these drugs cause dose-related centrally mediated respiratory depression. Moreover, benzodiazepines are contraindicated in patients with my asthenia gravis, so treating myasthenia gravis patients with insomnia is difficult.
A 67-year-old woman developed myasthenia gravis on December 20XX. Her myasthenia gravis went into remission with oral high-dose prednisolone medication and plasma exchange, after which her oral predniso lone medication was continued. On January 20XX+2, she suffered from insomnia. She had poor sleep quality, nocturnal awakenings and middle-of-the-night insomnia. She had high abdominal resistance and fullness, ten derness, and discomfort of the hypochondrium. She was treated with saikokaryukotsuboreito and could then sleep comfortably soon afterwards.
According to the Shang Han Lun, saikokaryukotsuboreito is effective for susceptibility to fright and deliri ous speech. Although our patient had no psychological symptoms such as these, an abdominal palpation examination led to diagnosis of a Sho (indication) for saikokaryukotsuboreito. So we started therapy with saikokaryukotsuboreito and her insomnia began improving immediately. To our knowledge, this is the first report of an insomnia patient with myasthenia gravis successfully treated with saikokaryukotsuboreito. Saiko karyukotsuboreito is not contraindicated in patients with myasthenia gravis. Thus we conclude that saikoka ryukotsuboreito is effective and safe for insomnia patients with myasthenia gravis.

Dementia of the Alzheimer's type, in which cognitive impairment slowly progresses, accounts for more than half of dementia cases. Symptoms develop slowly and worsen over time, and there is no cure for Alzheimer's type dementia. We conducted a study on the efficacy of hangebyakujutsutemmato for cognitive impairment in dementia of the Alzheimer's type. Seventy-two patients with Alzheimer's type dementia were enrolled in our study. Hasegawa dementia scale-revised (HDS-R) was implemented for all patients, for whom hangebyakujutsutemmato medication was started at the initial visit. After 4-weeks' treatment the HDS-R was implemented again. Sixty-four patients were assessable and 8 patients dropped out from the study. In these 64 patients, mean age ± standard deviation was 79.9 ± 6.0, and 33 patients were male, and 31 patients were female. After 4 weeks of hangebyakujutsutemmato treatment, HDS-R scores were increased significantly compared with baseline (from 15.5 ± 5.2 to 16.9 ± 6.2, p < 0.01). In taking histories from families, clinical presentation was shown to have improved in 13 patients (20.3%). To our knowledge, this is the first report demonstrating that hangebyakujutsutemmato is effective for patients with dementia of the Alzheimer's type. In conclusion, hangebyakujutsutemmato is a useful option for the treatment of cognitive impairment in Alzheimer's type dementia.

Blepharospasm is classified as a focal dystonia, and involves involuntary contraction of muscles such as the orbicularis oculi muscle and the corrugator muscle, which are associated with eyelid movement. Thus blepharospasm involves difficulties to eyelid opening. A 61-year-old woman came to our hospital complaining of a sense of discomfort of the eyes since a half year earlier. Blepharospasm was diagnosed based on current medical history and neurological examination. Oral saikokaryukotsuboreito was started and the blepharospasm improved gradually. After a week, oral treatment with one-third of the amount of shakuyakukanzoto was added and the blepharospasm further improved. The patient wanted to increase the dose of shakuyakukanzoto and to stop the saikokaryukotsuboreito. Once oral shakuyakukanzoto monotherapy was started, however, the blepharospasm worsened. Oral saikokaryukotsuboreito and low dose shakuyakukanzoto was started again, and her blepharospasm improved again.
The mechanism behind a focal dystonia such as blepharospasm is explained as a disorder of the basal ganglia motor loop. Saikokaryukotsuboreito is used for the diseases of the central nervous system. Thus there is the possibility that, here, saikokaryukotsuboreito improved a central nervous system disorder, and the blepharospasm. To our knowledge, this is the first report demonstrating that saikokaryukotsuboreito is effective for blepharospasm. It suggests that saikokaryukotsuboreito is a useful option for the treatment of blepharospasm.

This study examined the association of physical activity (PA) and sedentary behavior (SB) with chronic low back pain (CLBP) in older adults. Cross-sectional data were collected from 715 elders aged 65 years and over living in Dazaifu, Japan. CLBP was defined as pain that sustains more than 1-3 months within the past year. PA and SB were objectively measured using a triaxial accelerometer (Omron Healthcare, Active style Pro (HJA 350IT)). Participants were categorized into four groups (2 groups of PA×2 groups of SB) according to their levels of PA and SB (divided into 2 levels; low and high levels around the median). Logistic regression analysis was used to examine effect of PA/SB with CLBP. In the analyses, sex, age, body mass index, smoking, educational attainment, falls, handgrip strength, knee pain and non-locomotive activities were treated as potential confounders. The prevalence of CLBP was 35%. After adjustment of confounding factors, significantly higher risk of CLBP was shown only in Low PA/High SB group (odds ratio : 1.66, 95% confidence interval : 1.02-2.70), compared with that of the reference group (High PA/Low SB group). These results suggest that the combination of low PA and high SB might be the risk of CLBP. Future studies should try to clarify whether CLBP is a cause or a consequence of inactivity.