Introduction: Patients of end-stage heart failure often develop dyspnea. Although morphine is used for dyspnea, these patients are often inappropriate group for using morphine due to renal failure. Case: A seventy-year-old male with end-stage heart failure due to dilated cardiomyopathy developed dyspnea. We used continuous oxycodone infusion for dyspnea with small dose as an alternative to morphine due to renal failure. His dyspnea was relieved in dose-dependent without heart failure recovery. Conclusion: Oxycodone may be an alternative therapy for dyspnea with end-stage heart failure with renal failure.

Purpose
  The purpose of this study is to clarify the impressions that elderly people requiring care have when exposed to a “rooftop forest-like field.”
Methods
Experimental sites : (1) The rooftop forest-like area: It covers an area of 122 m² on the 3rd story rooftop of a health service facility. It has 140 cm undulations, and a murmuring stream 7 m long and 58 cm deep flowing through the center. Fifty-one species of trees and 33 species of weeds, herbs, and grasses have been planted. Nearby is a mountain from which some birds come to the area. This mountain formed the background to this landscape. (2) The outdoor parking area: Control area was an area of 170 m² next to the same facility. Cars were prevented from entering during the study.
Subjects:The subjects were 30 females aged from 71 to 95 (mean ± SD: 81.7 ± 5.6). They were residents of the facility or attended to the facility for day care. They were divided into two groups, A and B, consisting of 15 females each. The groups were matched for age and cerebral vascular disorders (CVD). No patients with dementia were included. Experimental design : On the first day of The experiment, group A was sent to the rooftop forest-like area, and group B was sent to the open-air parking area. On the second day, each group went to the other area to eliminate the order effect. The subjective impression was measured using the semantic differential (SD) method. Patients sat still in a wheelchair and watched the scenery for 7 minutes and then answered the questionnaire.
Results and Discussion
  The rooftop forest-like field was perceived as a “beautiful,” “refreshing,” “orderly,” “enjoyable,” “comfortable” “secure,” “healthy,” “calm,” “soothing,” “friendly,” “quiet,” and a “holy” area. It was similar to the impression made by natural coniferous forests or natural rice fields. More than 80% of subjects expressed subjective relaxed state, as “most enjoyable,” “most comfortable,” and “most secure” as their impressions of the rooftop forest-like area. The impression of rooftop forest like area was characterized by high scores for both space and sensory factors using the SD method. Compared with previous reports, this forest-like area may have a relaxing effect on elderly people requiring care which is subjectively perceived.
Conclusion
  It was demonstrated that the rooftop forest-like field was perceived as a “comfortable”, “healthy”, and “relaxing” space by elderly people requiring care.