Objective: To reveal the current use of medication notebooks in clinical practice and the differences in submission rates of medication notebooks among patients with different sociodemographic and medical characteristics.
Methods: We conducted a survey of the submission rates by studying the medication history, from June 19, 2014, to July 3, 2014.
Results: The overall submission rate of returning patients was 57.1% and the submission rate of patients who visit a single medical institution was significantly lower than patients who visit more than two (55.4% vs. 67.7%, p<0.001).  Multivariate logistic regression also indicated significant differences between the single and multiple medical institution visit group (adjusted OR=2.74 [95% CI: 1.93-3.89], p<0.001).  Submission rates for patients in their 20, 30, and 50 s who visit a single medical institution were lower than 40%.
Conclusions: To improve the usefulness of the community pharmacy and increase the submission rate, we need to increase awareness of the importance of medication notebooks among patients who visit a single medical institution.  Additionally, future studies need to focus on factors such as age-related issues that might affect submission rates.

We experienced a case of delayed-onset Wallenberg's syndrome following cervical spine fracture coexisting with suspected conversion disorder. A 69-year-old man was involved in a traffic accident, and was admitted to our rehabilitation unit for the purpose of posttraumatic rehabilitation. At first, he complained of right occipital and nuchal pain. But his complaints changed to ataxia, dysphagia and a suspected brainstem lesion four months after the accident. His brainstem MRI showed a small ischemic lesion in the right dorsolateral area of the medulla oblongata. The long time lag between the original traumatic event and his changing complaints made the diagnosis difficult. Accordingly, rehabilitation assessment and conventional rehabilitation approaches were prepared for all of his symptoms. The dysphagia and ataxia were gradually reduced and the hemiparesis lessened and disappeared. A couple of points were suggested by this case. The first is “We must never overlook a change of neurological symptom masked as conversion disorder, and never deny what the patient says without careful listening.” The second is “We should offer the patient a conventional rehabilitation program without the option for malingering and falsification. This case might suggest that our attitude toward so-called gray-zone cases has an influence on the functional/social prognosis.

　　The aim of this study was to examine topophilia in the elderly living in mountainous areas. Topophilia, which is the geographical concept invented by Yi-Fu Tuan in 1999, is defined as the affective bond between people and place or environmental setting. A total of 120 elderly subjects living in a mountainous area responded to a standardized, validated 9-item Life Satisfaction Index K (subjective well-being) developed by Wataru Koyano and a new structured 6-item questionnaire on topophilia. Factor analyses revealed two domains of topophilia (public emotion and private emotion toward the living place). Public emotion was the emotion of being hard to leave the living place. Private emotion was the emotion of not loving the living place. There were areas where the elderly had a lesser degree of attachment toward the present state of the elderly could hardly have a sense of well-being and attachments to the current domicile. It is considered that not only physical but also mental approach is necessary to support the daily life of the elderly living in the mountainous area. Also, we examined the influences of aging and the living place on a subjective well-being and topophilia. There was no significant correlation between age and subjective well-being, but there was significant positive correlation between age and the degree of topophilia (r＝0.234, p‹0.01). On the other hand, the degree of subjective well-being by the place of residence was significantly different (p‹0.001; ANOVA), and the degree of topophilia by the place of residence was not significantly different. These findings suggest that subjective well-being is not influenced by age but influenced by the place of residence, and topophillia is not influenced by the place of residence but influenced by age.

  We examined how difficult it would be for the elderly living in mountainous areas to go to the nearest hospital using a Voronoi tessellation representing the mathematical concept of neighborhood. We defined the index of the nursing-care capacity for the elderly as the ratio of the number of caregivers to the number of the elderly receiving nursing-care.
  The mean age of those who drive to the hospital by themselves worked out at 70±9.8 years. Meanwhile, that of those who go to the hospital by bus or taken to hospital in a car driven by a family member came to 80±7.0years. The latter was significantly older than the former.
  The areas of the Voronoi tessellation generated by patients' places of residence were divided into three groups according to the size. The plots of these three groups of the the places of residence on the map had a three-layer and doughnut-like structure, i. e., inner-, middle-, and outer-layer.
  The index of the nursing-care capacity in 2008 was less than 1.0 for the patients under 80 years of age. This means that when those who were at the age of 50 in 2008 become old and need nursing-care, access to the hospital will become harder to them than at present. For those who are over 80 years of age and live in the outer layer that is far away from arterial road, it will be almost impossible.
  These findings suggest that outpatient care with transportation assistance by a family member at present should be reconsidered because of the future lack of care personnel. It would also be necessary to consider the welfare of older people from the geographical point of view in order to manage the problems concerning the various physical and sociological difficulties of the elderly.

A 52-year old woman was referred to our hospital because of abdominal pain and restlessness. A chest contrast-enhanced CT showed huge pericardial effusion and intraluminal defects in the main pulmonary artery. We could not make a diagnosis based on the cytology of the pericardial effusion and histopathology of the mass with a sample taken by a catheter. Therefore, we undertook biopsies of the mass by median sternotomy, which led to the diagnosis of pulmonary intimal sarcoma. The tumor resection was performed to release the right ventricular outflow stenosis. We tried to resect the tumor as much as possible, and reconstructed the pulmonary artery and aortic root. She was discharged to home and survived 5 months after surgery.