Objective
Seventeen patients with FMS were treated with balneo-Morita therapy, which combines the balneotherapy with Morita therapy. After one year of treatment, patients with favorable outcome were compared with those with poor outcome.
Subjects and methods
The mean treatment period was 4.3 weeks. The outcome after one year of treatment was assessed. Patients who were able to return to work without a relapse of FMS were classified into the responsive group (13 cases, 74.6% in all), and those who showed a relapse or were not able to return to work were classified into the unresponsive group (4 cases, 23.5%). The cases of these two groups were compared in terms of biological (physical), psychological, social and existential status induvidually.
Results
There was no significant difference in sex or age distribution between the two groups. In terms of disease entity, FMS can be classified into psychosomatic type (hyperadaptation type) and neurotic type (possible presence of psychosocial-existential problems which are difficult to resolve such as great trauma, or the conditions ranging from neurosis to psychosis). Cases of neurotic type were prevailing in the unresponsive group. Patients were assessed to find out in which of the particular features of biological, psychological, social and existential aspects the notable problems proper to each patient lie.
The number of patients having psychological problems was higher in the unresponsive group, with a significant difference. In one case of the unresponsive group, the condition changed into ME/CFS (myalgic encephalopathy/chronic fatigue syndrome).
Discussion
In the treatment of these patients, the somatic approaches or physical therapy such as pharmacological therapy or simple balneotherapy, should be given more importance for cases of the psychosomatic type. However, psychological therapy should be added to this treatment for cases of neurotic type. The efficacy of the balneo-Morita therapy was compared between the groups as classified by the type of the disease. The therapy was effective in 91.6% of the cases of psychosomatic type, while the efficacy rate was 40.0% for cases of neurotic type. During the period of the balneo-Morita therapy, a tendency of dependency on therapists may appear in patients. Although involution may be allowed transiently for the purpose of introducing catharsis, autonomy should be enhanced eventually. Yuatari (balneo-phenomenon, or balneo-intoxication) is a phenomenon, that develops in psychosomatic confusion resulting from sudden release from tension after the start of balneotherapy. This phenomenon is regarded as catharsis, from which patients are encouraged to establish a new self. Through this therapeutic experience, the therapists lead the patients from involution to autonomy without being so instructed, finally to cause a change in the way of living. In cases of psychosomatic type, this conversion was relatively easily achieved, but in cases of neurotic type such conversion was difficult. It is considered that difficulty in such conversion is attributable to psychological factors of patients (strength of self, severity of trauma, presence or absence of meaning, autonomy).

Objective: Prescription check and inquiry is one of the most important operations of pharmacists to provide optimal drug therapy to the patient.  Although a number of studies related to inquiries of prescriptions have already been reported, there is little report about requests for doctor and hospital based on the examples.  Therefore, this study aimed to clarify the current problems revealed by inquiries about prescriptions by not only analyzing these inquiries but also investigating requests for doctors and hospitals.
Methods: We investigated 6,255 inquiries about prescriptions and requests for doctors and hospitals at 584 insurance pharmacies from August 4 to 10, 2014.  Then, the inquiries about prescriptions and requests for doctors and hospitals were categorized.
Results: The most frequent category of inquiries about prescriptions was “Questions about administration and dosage” (21.5%).  On the contrary, the most frequent request for doctors was “Efficiency in gathering information from and providing information to a patient” (2,067 cases).
Conclusions: The present study clarified current problems revealed by inquiries about prescriptions by investigating requests for doctors and hospitals that were based on examples.  Furthermore, the problems were classified into ten categories, and these should be noted by doctors and hospitals at the time the prescription was issued.

Background: and Purpose To assess the long-term outcomes of intracranial dural arteriovenous fistula (DAVF) treated with stereotactic radiosurgery (SRS) alone or embolization and SRS (Emb-SRS) and to develop a grading system for predicting DAVF obliteration. Methods: This multi-institutional retrospective study included 200 patients with DAVF treated with SRS or Emb-SRS. We investigated the long-term obliteration rate and obliteration-associated factors. We developed a new grading system to estimate the obliteration rate. Additionally, we compared the outcomes of SRS and Emb-SRS by using propensity score matching. Results: The 3- and 4-year obliteration rates were 66.3% and 78.8%, respectively. The post-SRS hemorrhage rate was 2%. In the matched cohort, the SRS and Emb-SRS groups did not differ in the rates of obliteration (P=0.54) or post-SRS hemorrhage (P=0.50). In multivariable analysis, DAVF location and cortical venous reflux (CVR) were independently associated with obliteration. The new grading system assigned 2, 1, and 0 points to DAVFs in the anterior skull base or middle fossa, DAVFs with CVR or DAVFs in the superior sagittal sinus or tentorium, and DAVFs without these factors, respectively. Using the total points, patients were stratified into the highest (0 points), intermediate (1 point), or lowest (≥2 points) obliteration rate groups that exhibited 4-year obliteration rates of 94.4%, 71.3%, and 60.4%, respectively (P<0.01). Conclusions SRS-based therapy achieved DAVF obliteration in more than three-quarters of the patients at 4 years of age. Our grading system can stratify the obliteration rate and may guide physicians in treatment selection.

Introduction: We report a case of sudden loss of consciousness due to hypoglycemia in the terminal stage of cancer. Case: A 73-year-old man underwent craniotomy in 2016 and was diagnosed with solitary fibrous tumor. In 2022, his brain tumor recurred and he was admitted to our hospice. On the morning of the 120th day after transfer, the patient suddenly developed impaired consciousness. Blood tests showed hypoglycemia (33 mg/dL), and intravenous glucose injection improved his loss of consciousness, leading to a diagnosis of impaired consciousness due to hypoglycemia. After various examinations, hypoglycemia due to extrapancreatic tumor (non-islet cell tumor hypoglycemia: NICTH) was strongly suspected. Discussion: NICTH is considered to be caused by excessive secretion of an insulin-like substance (high molecular weight insulin-like growth factor (IGF-)II) from the tumor. In patients who are exposed to hypoglycemia for a long period of time, central nervous system symptoms such as impaired consciousness may suddenly develop without sympathetic symptoms. NICTH should be considered as a differential diagnosis in patients with delirium, impaired consciousness, or convulsive seizures and a large tumor, although it is not easy to prove the excessive secretion of high-molecular-weight IGF-II, especially in the terminal stage of cancer.

Although cardiac rehabilitation (CR) has been shown to improve exercise tolerance and prognosis in patients with cardiovascular diseases, there remains low participation in outpatient CR. This may be attributed to the patients’ busy schedules and difficulty in visiting the hospital due to distance, cost, avoidance of exercise, and severity of coronary disease. To overcome these challenges, many countries are exploring the possibility of remote CR. Specifically, there is increasing attention on the development of remote CR devices, which allow transmission of vital information to the hospital via a remote CR application linked to a wearable device for telemonitoring by dedicated hospital staff. In addition, remote CR programs can support return to work after hospitalization. Previous studies have demonstrated the effects of remote CR on exercise tolerance. However, the preventive effects of remote CR on cardiac events and mortality remain controversial. Thus, safe and effective remote CR requires exercise risk stratification for each patient, telenursing by skilled staff, and multidisciplinary interventions. Therefore, quality assurance of telenursing and multi-disciplinary interventions will be essential for remote CR. Remote CR may become an important part of cardiac management in the future. However, issues such as costeffectiveness and insurance coverage still persist.

Residents have teaching roles in clinical practice, and the importance of these roles has been pointed out. This is due to their proximity to learners as Near-Peers. There are two aspects to consider: cognitive proximity, which allows them to share what learners don’t know, and spatial proximity, which allows us to share time and space for an extended period. Residents-as-teachers programs, which aim to improve teaching skills for residents, are being developed all over the world, but are still rare in Japan. We are conducting research to determine what teaching competencies residents should have. We are running a one-year fellowship based on the results of that research. The scale of the program has gradually increased, and in 2020, due to COVID-19, the fellowship went online. We restructured the fellowship in terms of Study/Workload, Enhancing Engagement, and Technical Issues. We received high satisfaction ratings for the online implementation.