1) An objective method which included the determination of muscle strength, range of passive joint motion, and also activities of daily living, was used to evaluate physical abilities and disabilities of hemiplegic patients along the course of rehabilitation. The data obtained by this method was statically analysed. 92 patients, who had suffered from a cerebrovascular accident more than 3 months previously, were examined and treated on one month rehabilitation course with balneotherapy.
The results were promissing in spite of the short duration of the treatment.
Group A (patients with duration of hemipiegia for 3-6 months after the cerebrovascular accident) showed 78.6% of the normal A. D. L. at the end of the treatment while the control group showed only 64.4% of normal.
Group A showed a gain of 48.7% in the improvement of A. D. L., group B (duration of hemiplegia for 6-12 months after onset) 40.8%, and group C (over 1 year after the cerebrovascular accident) only 31.6%.
The relationship between the improvement in A. D. L. and the time intervall between the start of the treatment and the onset of the cerebrovascular accident proved statically significant, namely, the earlier was the start of the rehabilitation, the better was the clinical improvement.
The improvement in muscle strength was not so marked as in A. D. L.
The ralationships between improvement in A. D. L., in muscle strength and in the range of passive joint motion all proved statistically significant.
Patients who were under 59 years of age gained significantly more improvement in A. D. L. and muscle strength than the patients who were over 60 years of age. It seems to the authors that this derives from a diminished will of the patient to recover and a decrease in the amount of exercise in the older aged group.
Concerning the range of passive joint motion, group A showed improvement of 47.1%, group B 46.1%, and group C 35.2%. Regarding these remarkable improvements, there was no difference between the older age group and the younger age group. It seems to the authors that the improvement of the range of passive motion of joints derives from the relief from the pain by spa treatment, which resulted from contracture and other pathologic changes around the joints.
The authors conclude that, along with some favorable effects of balneotherapy on the basic disorders of the cerebrovascular accident, an utility of balneotherapy in the rehabilitation of hemiplegic patients lies in this improvement in the range of passive motion of joints as mentioned above which must have favorable effect on active exercise.
2) Improvement in A. D. L. of 21 stroke patients (cerebral hemorrhage -7 cases; thrombosis -8 cases; unclassified -6 cases.) to whom passive exercise of the affected site of extremities was introduced shortly after a stroke, was examined similarly as mentioned above.
In the cases of cerebral thrombosis, passive movement was begun 2 hours after the stroke, and in the cases of cerebral hemorrhage or unclassified cause, 2-3 days thereafter.
Among 6 fatal cases, 5 died within a week after the stroke when the passive movement was not yet introduced.
Among 15 survived patients, 11 cases (73%) got over 75% of normal A. D. L., and only 2 cases (13.3%) remained under 25%.
No case of the second attack was seen through the course of rehabilitation.
3) The repeatedly evoked E. M. G. was studied before and after a thermal bath of Kageyu (simple thermal spring), and plateau level changes were compared with impovement in A. D. L., M. S., and R. P. J. M.
Plateau level changes by thermal bath are considered to be determined by α and γ system conditions, and the improvements of A. D. L. by the spa treatment could not be interpreted by the E. M. G. changes.

PURPOSE: Ticlopidine hydrochloride, an antiplatelet agent, is believed to have saved life years in many patients with ischemic cerebral vascular diseases in Japan. But severe adverse events have also been reported. The current investigation aimed to compare two hypothetical cohorts treated with and without ticlopidine in terms of risks and benefits of ticlopidine treatment using Markov model.
METHODS: We conducted Markov decision analysis to estimate the number of lives saved and the increase in quality-adjusted life years (QALYs) over the past 20 years by ticlopidine in Japan. Two cohorts of 60-year-old male patients with previous histories of cerebral infarction, one of which treated with ticlopidine and the other not treated with ticlopidine, were compared with respect to the number of deaths and quality of life (QOL) . Data incorporated were the probabilities of the recurrence of cerebral infarction and the associated mortality, adverse events of the drug, and the utility of health status treated with ticlopidine.
RESULTS: Approximately 1, 630, 000 patients were estimated to be on ticlopidine for variable periods of time during the past 20 years in Japan. With treatment, 17, 130 lives were saved, while 1, 338 patients died because of cerebral bleeding, agranulocytosis, severe hepatic dysfunction, or thrombotic thrombocytic purpura, resulting in a net benefit of 15, 792 lives saved by ticlopidine over the past 20 years. In terms of QOL, there was a total increase of 382, 191 QALYs. Sensitivity analyses showed that the older the patients when ticlopidine therapy was started, the smaller the benefits that were gained by treatment.
CONCLUSIONS: Ticlopidine is considered to have made a great contribution in savingmany lives and improving QALYs in the past 20 years in Japan. This kind of analysis based on Markov model can be employed to demonstrate effectiveness of drugs and medical technologies in terms of population health outcomes.

BACKGROUND: The existence of a gap between research evidence and clinical practice has been described recently. Several drugs are effective in preventing secondary events after acute myocardial infarction (AMI), but it is not certain whether this evidence is employed in daily practice. We investigated the drugs currently employed for patients with a history of AMI in Japan.
METHODS: Medical records of patients who developed AMI during the calendar year of 1999 were retrospectively identified at three teaching hospitals in Japan. We collected data on drugs prescribed at three time points (upon admission for AMI, at the time of discharge, and one year after discharge) for each patient.
RESULTS: Data were available for 149 patients with AM!. Drugs prescribed at the time of discharge were aspirin (77.5%), nitrates (68.3%), and angiotensin converting enzyme inhibitors (52.8%) . β-blockers were prescribed for only 12.0% of patients. The drugs used one year after discharge were to a large extent similar to those at the time of discharge. There were no significant correlations between the use of these drugs and comorbidity.
CONCLUSION: Despite established evidence that β-blockers offer benefits to patients with a history of AMI, they have not been prescribed frequently, for reasons that remain unclear. To improve the quality of clinical care, further systematic effort is needed to bridge this evidence to practice gap.