1) Anjo Kosei Hospital has nearly 40 years of history of the post-primary clinical training course.
2) More than 90% of the young doctors, passed through 2 years of the primary clinical training course, have chosen further training at Anjo Kosei Hospital. During this course they began to start the experience for their own career for specialist.
3) This education program is closely coordinated with Medical Colleges such as Nagoya University and Nagoya City College of medicine. After 4 or 5 years of training at Anjo Kosei Hospital, they continued their training at Nagoya University Hospital or Nagoya City College Hospital for the further career.

BACKGROUND: In recent years, various studies have analyzed the concepts of “good death” and “quality of dying and death” in the world. The objective of this study was to compare community residents and physicians regarding their perceptions of “good death” in a terminal cancer setting in Fukushima, Japan.
METHODS: One thousand residents of Fukushima City (40 years or older) were randomly selected for comparison to the 483 physicians working in the same city. A self-administered questionnaire was used to query residents and physicians on 52 items about “good death.”
RESULTS: The response rate was 73.6% for the residents and 53.0% for the physicians. The concept of “good death” was composed of 14 factors for both groups. We elucidated the structure of the concept of “good death” in the general population and physicians in Japan, and only the third factor, “religion and spiritual beliefs, ” was the same between the general population and physician.
CONCLUSION: The data offers useful information pertaining to palliative care education for medical providers. Specifically, physicians should understand the differences between concepts held by the general population and physicians. For example, some same items were included in factor X (continuance of one's lifestyle) for citizen and factor II for physician. But contribution ratios of factor X for citizen and factor II for physician were different. This should lead to the better palliative care provision.

We evaluated the influence of a twice-weekly group exercise program on visceral fat area (VFA) and plasma adiponectin (APN) in the elderly. Thirty-three community-dwelling elderly (age : 72.4±6.9 yrs) participated in a 12-week supervised, geriatric exercise training program (GET) followed by a 12-week unsupervised GET (u-GET), which included stretching, strengthening, and balance-training exercises. Participants were evaluated for physical fitness, blood glucose, HbA1c, triglyceride, cholesterol, insulin, and APN. VFA was measured by computed tomography. All measurements were taken before the GET (TR1), after 12-weeks of GET (TR2), and at the end of the u-GET (TR3). Twelve weeks of GET produced significant increases in physical function measures. Both walking speed and functional mobility values at TR3 were significantly higher than TR1 values. A significant reduction in VFA was seen at TR3 in men. APN progressively elevated from TR1 to TR3 in women. In the frail elderly, 12 weeks of GET effectively increased functional ability and APN. The beneficial effects on VFA and APN were sustained following the participation in the unsupervised setting, suggesting that the frail elderly should be encouraged to participate and maintain a resistance training routine to achieve preferable effects on both functional ability and cardiovascular risk factors.

Since 1993, we have used a clinical clerkship method in an attempt to improve the undergraduate clinical training in our department. At first, the students were given the opportunity to learn adequate basic clinical procedures (levels 1 to 3), but data on the effect of their training were lacking. Therefore, we conducted a survey to obtain the necessary information. Twenty-nine students (29 % of students in the sixth academic year) participated and wrote their survey reports at the end of the course. The reports were designed to evaluate their problem-solving skills and the effects of self-directed learning in clinical anesthesia and to obtain an overall impression of the training. The results revealed that the educational effect was insufficient for almost all students who participated because they were unable to fully solve the problems of anesthetic management from either a pathophysiologic or pathobiochemical standpoint. From these results and our further experiences from 1994 through 1996, we decided to reform our educational procedures. The important improvements are as follows. 1) Trainees must record the anesthesia course during the assigned anesthetic case and participate in the postoperative ward discussion. 2) A member of the teaching staff must discuss ways to manage and solve problems with trainees at the end of each case. 3) After the discussion, trainees must write a report about how and what they have learned.

In this study, we examined changes in the amplitude of differential digital photoplethysmogram (ΔDPG) and the power spectral changes of EEG at rest during cold water immersion of the contralateral fingers (2°C), and after alcohol intake (0.3 g/kg) in 8 male subjects. This experiment showed that the ΔDPG amplitude decreased at rest and finger blood pressure was increased during the cold water stimulation, but there was no signifincant change in heart rate and EEG power spectrum. On chronological measurements for 30 minutes after alcohol intake, ΔDPG amplitude decreased slightly and finger blood pressure increased. Heart rate also tended to increase, and the alpha 1 power (8.0-9.8 Hz) on EEG gradually increased. The ODPG and finger blood pressure responses to cold water stimulation every 10 minutes was decreased after alcohol intake, whereas heart rate was not affected. However, a decrease in the alphal power after stimulation was revealed. From these results, it may be concluded that during 5-10 s of cold water stimulation, increased skin sympathetic nerve activity was one of the factors that raises blood pressure.

We report the case of a 51-year-old woman whose body weight was increased after bariatric surgery. She has been obese from a young age. When she was 30 years old, she developed type 2 diabetes mellitus. She was hospitalized for diabetic ketoacidosis at 45 years of age. She was diagnosed bulimic at 48 years of age, and body weight reduction with diet and exercise therapy became difficult because she was bulimic. Then, she underwent bariatric surgery and her body weight had reduced by 11 kg, 6 months after the surgery. However, her body weight began to increase again 7 months post surgery. At this time, her mental status had become unstable and she ate constantly in the afternoons. We administered yokukansan 5 g/day to treat her unstable mental status. Her body weight then decreased in accord with decreasing energy intake after the administration of yokukansan. She also became aware that her mental status was improving. Furthermore, her HbA1c (JDS) decreased from 8.7% to 7.1% after yokukansan treatment. In this case, it is possible that yokukansan suppressed the overeating by stabilizing her mental status, with the parallel decreases in body weight and HbA1c.

In our previous study, a prolactin elevation was more frequently in risperidone than in blonanserin; however, it was more often in blonanserin than in olanzapine. Therefore, while a rate of PRL rising is low to moderate, hyperprolactinemia is a considerable adverse effect in the blonanserin treatment. In this study, to examine detailed characteristics of hyperprolactinemia of blonanserin, we analyzed the prolactin data in six schizophrenic patients who were switched to blonanserin from other antipsychotics and followed for one year. As a result, blonanserin dose was clearly associated with serum prolactin level. The average prolactin level was almost normal when the mean blonanserin dosage was 8.0 mg/day. Regardless of the dose decrease of blonanserin, there were no remarkable changes in symptoms and social functions. Based on our findings, we conclude that low dose blonanserin medication may be useful for schizophrenia maintenance treatment without hyperprolactinemia and a high rate of relapse.
Antipsychotic Agents ; Follow-Up Studies* ; Humans ; Hyperprolactinemia ; Prolactin* ; Recurrence ; Risperidone ; Schizophrenia*

In Palliative care, we meet patients with easy-bleeding superficial malignant tumors, such as head and neck cancer, skin metastasis of all kinds of cancer and unresectable breast cancer. But it is not easy to control bleeding even though we use various means, and many doctors have difficulties in stopping bleeding. We report a case with a recurrent tumor of pharyngeal cancer that showed easy-bleeding and discharged massive exudates. Although she received several alcohol local injections because of bleeding of the tumor, she needed a dressing change over 5 times in a day. It made her QOL worse. In this case, we used Mohs paste and after using it, the surface had been fixed and dried up, resulting in a decrease in bleeding, exudate, frequency of dressing change and bad odor. Mohs paste was made of distilled water, zinc chloride, zinc starch and Glycerol. Zinc chloride changes to zinc ion by water in the wound and makes protein cohere and thereafter tissues, vessels and cell membrane of bacteria are fixed chemically. We could stop bleeding for 15 days with only 20 minutes contact with Mohs paste, and massive exudates and bad odor decreased. Mohs paste, which is made in your hospital pharmacy with cheap materials, can be used for bleeding or massive exudates repeatedly if there is not a thick blood vessel anatomically under the tumor. It was effective to improve her QOL. Palliat Care Res 2009; 4(2): 346-350