Objective: Bakumondo-to (Mai men dong tang, B), a traditional Chinese blended medicine, has notable antitussive activity in bronchitic guinea-pigs. In this study, we examined whether or not B was effective in treating postinfectious cough.
Methodology: Consenting, non-smoking patients who met the following diagnostic criteria were selected as subjects: (1) those who had been coughing continuously for more than two weeks postinfectiously; (2) who did not use angiotensin-converting enzyme (ACE) inhibitors orally; (3) who had no history of nasal and/or paranasal disease, chronic pulmonary disease, atopy or gastroesophageal reflux disease; and (4) who had normal chest X-rays, respiratory function, peripheral eosinophil counts, levels of C-reactive protein, and serum IgE concentrations. Subjects were randomized into two groups: those given a daily dose of 9g of B extract granules orally for one week, and those given a daily dose of 60mg dextromethorphan hydrobromide (D) orally for one week. Using a cough diary (in which cough was scored from 0 to 9 points), we compared and studied the antitussive effects between the two groups.
Results: Group B was comprised of thirteen patients, and Group D, twelve. There were no significant differences between the two groups with respect to age, sex, cough scores at the time of hospital visits, duration of continuous coughing, and test results. Significant antitussive effects were seen in both groups. However, cough scores decreased significantly from the second day for the B group, and on the third, sixth and seventh day for the D group. Compared with the D group subjects, those in the B group showed higher antitussive effects on the second days (P<0.05). No serious side effects were observed for either group.
Conclusion: In this randomized open trial, we concluded that Bakumondo-to is an effective treatment in non-smoking patients with postinfectious cough, and it appears to demonstrate an antitussive action immediately after administration.

The effects of psychosocial education on undergraduate medical students were evaluated in an open trial. Undergraduate medical students were exposed to psychosomatic medicine and, in particular, holistic medicine as part of their undergraduate medical education. Almost all students (94.9%) reported addressing “extramedical” clinical problems with a holistic approach (n=98). Psychological, social, and economic problems were mentioned in 64.3%, 50.0%, and 5.1% of reports, respectively. Problems in relationships between members of the medical staff and patients were included in 37.8% of reports. Self-evaluation with the Egogram Check Lists by students who had undergone clinical practice revealed scores of “Critical Parent, ” “Nurturing Parent, ” “Adult, ” “Free Child, ” and “Adapted Child” of 2.59 1.57, 4.59±1.89, 4.79±1.54, 4.85±1.64, and 4.65±1.64, respectively (n=82). “Adult” scores were higher after clinical practice than before (n = 32, p<0.02, Student's paired t-test). Clinical practice seemed to help students mature and become better able to cope with problems objectively. Education in psychosomatic medicine is an important component of undergraduate medical education.

At the Niigata University School of Medicine, objective structured clinical examinations (OSCEs) were performed for the first time in 2001 for 92 fourth-year medical students. The average evaluation scores students received from instructors were summarized, and the differences between scores given by different instructors were examined. We found that practice methods for the medical interview and physical examination before OSCE and the question topics and evaluation methods of OSCE were appropriate, but scores on some items were extremely low. The standardization and objectivity of the evaluation were satisfactory, perhaps because one explanatory conference and two training conferences were held for instructors before OSCE. However, some questions tended to produce differences between instructors, as did some topics, especially in the medical interview. The scores with standardized patients and those by teachers were strongly correlated, but those with the former were lower than those by the latter.

The aim of this study is to validate the effect of a nutrition support team's (NST) interventions in convalescent stroke rehabilitation using the Functional Independence Measure (FIM). Three hundred and four patients were retrospectively divided into an NST-nourishment group, an NST-losing-weight group and a non-NST group. We then compared the FIM gain, the FIM efficiency and the change of body mass index during admission among these three groups. The FIM gain was 17.3±15.9 in the NST-nourishment group and 16.7±12.5 in the non-NST group and there was no significant difference. The FIM efficiency in the NST-nourishment group (0.20±0.19) was significantly lower than the one in the non-NST group (0.27±0.19). Patients with an FIM of 53 or less showed no significant difference in FIM gain and FIM efficiency between the two groups. Since those patients who received NST intervention would tend to have a poor prognosis in general, we assumed that our “no difference” results indicated the effectiveness of the NST intervention. There was no evident relationship between FIM gains and changes in the body mass index.

There is a theory that excessive treament for terminally ill patients is one of the factors in soaring medical costs. To evaluate this theory, we examined the changes in medical expenditures for our inpatients: 41 patients with lung cancer and 69 patients with liver cancer hospitalized for treatment of the department of internal medicine, and 90 patients with stomach cancer and 100 patients with colon cancer hospitalized for surgery from July to December 1997. They were divided to two groups: the patients of group A received active treatment, and the patients of group B received conservative treatment. We selected 10 people randomly from each group, and compared the changes in medical costs.
The cost was significantly low in group B compared with group A. We examined the change in the cost every 5 days. Until 6 days before leaving our hospital, the cost is high sugnificantly in group A compared with group B. The difference between group A and group B in the cost of treatment for lung cancer, and stomach cancer patients disappeared in 5 days before leaving hospital. The cost of treatment for lung and liver cancer patients of group A was a little higher than the average hospitalization fee of internal medicine. Also, the cost of group A stomach cancer patients was a little higher than the averge hospitalization fee of surgery, though there was no difference between the cost of treatment for group A colon cancer patients and the average hospitalization feeof surgery. The fee of group B of either disease was half or less of an average fee for medical treatment.
From this study, no evidence was found that the excessive life prolongation treatment for terminally ill patients was done. So, using authentic data, we should discuss the justifiability of the theory that the excessive treatment for terminally ill patients is one of the factors contributing to a boost in medical costs.

  In our hospital the palliative care committee has been held once a month since 2000. In 2007, a total of 1,583 cancer patients were admitted to our hospital orreceived medical care at home. The average length of hospital stay was 24 days. Of the total number of patients, 88.4% was informed that they had cancer. In the latter half of the year it increased to 92.6% because the palliative caretakers gave doctors accurate information on patients' psychology and social background. In October 2007 a questionnaire survey was conducted on those who visited our palliative care section on the occasion of the hospital festival. A total of 46 responded to our survey about the knowledge of palliative care, physician's precise explanation about the illness, image of opioids, desirable place of death and so on. Twenty-eight respondents (60.9%) did not know anything about palliative care. Forty-four (95.7%) wanted precise explanation of cancer. Thirty-four (73.9%) said they had had a night image of opioids after reading the panel. Twenty-eight (60.9%) responded they would rather stay at home until death. We should give healthy people more information about palliative care and opioids.

To restore gait function in paraplegic patients, hip-knee-ankle-foot orthoses are available. Orthoses maintain patient stability when standing and walking by restricting the degree of freedom the lower extremity joints. The disadvantages of orthoses include difficulties in standing and sitting movements, and the large burden placed on the upper extremities in walking. Usage of orthoses in daily living was therefore restricted. We are developing a gait assist robot, which we named WPAL (Wearable Power-Assist Locomotor). WPAL has a high degree of freedom and internal power for flexion-extension direction in each hip, knee, ankle joint. We compared WPAL with the conventional Primewalk orthosis as a preliminary investigation. (1) We compared independent standing ability and walking distance of a walker in WPAL and Primewalk orthosis. All three subjects achieved an independent level in standing and walking in WPAL, despite these users requiring assistance when using the Primewalk. Walking distances with the WPAL were several times greater when compared to walking distance with the Primewalk. (2) We performed a single case study using the patient who made the most entries into WPAL exercise. We compared heart rate, physiological cost index (PCI), modified Borg scale, lateral sway of trunk in 6 minutes walking on treadmill. His heart rate, PCI, and modified Borg scale were significantly lower and lateral sway was significantly smaller in WPAL gait. WPAL which has degree of freedom and internal power in the lower extremities is considered a step toward practical powered orthoses use in gait reconstruction for spinal cord injuries.

　At Showa University, which consists of the Schools of Medicine, Dentistry, Pharmacy, and Nursing and Rehabilitation Sciences, systematic interprofessional education for the purpose of training staff who can contribute to the medical team has been introduced with the cooperation of all 4 schools and through all undergraduate years. In the lower years, students study the basics of medical team care through a 4-school joint curriculum of experiential learning （such as early exposure） and problem-based learning inside and outside of the university. In the upper years, to acquire practical skills, students study the practice of medical team care through a joint curriculum of participatory learning in hospitals and the community. Through this curriculum, I expect that the medical staff to promote patient-centered team medical care in a variety of medical fields will grow in the future.