Objective: Myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) is an illness characterized by disabling fatigue lasting for at least 6 months. There are many controlled trials and case-control treatment studies that utilized immunological substances, pharmacological products, nutritional supplements, physical therapies, and cognitive behavioral therapy. Because of the unclear etiology, diagnostic uncertainty, and the resultant heterologeneity of the ME/CFS population, there are no firmly established treatment recommendation for ME/CFS. Recently Tei et al reported 2 CFS cases in whom thermal therapy improved the subjective symptoms. Thermal therapy has been reported to increase stroke volume and cardiac output in patients and improve the quality of life, sleep quality, and general well-being of these subjects. Thermal therapy using far-infrared ray dry sauna may be a promising method for the treatment of ME/CFS. We examined the applicability of Waon therapy (soothing warmth therapy) as a new treatment for patients with ME/CFS. Methods: Nine female ME/CFS patients (mean age, 38.4±11.2 years old; range, 21-60) who fulfilled the criteria of the Ministry of Health, Labor and Welfare of Japan and Canadian clinical case definition of ME/CFS participated in this study. The mean illness duration was 3.1±1.8 years (range, 1-6). The mean performance state was 6.9±0.9. The patients were placed in the sitting position in a infrared-ray dry sauna maintained at an even temperature of 45°C for 15 minutes, and then transferred to a room maintained at 26-27°C where they were covered with a warm blanket from the neck down to keep them warm for 30 minutes. They received thermal therapy twice a day for 3 weeks in hospital or once a day at the outpatient clinic for 5weeks. Their functional health and well-being scores were determined using SF-36 before treatment, after 30 treatments and during follow-up (mean follow-up period, 27.9±10.5 months; range 7-40). Results: Seven patients experienced a significant improvement in physical and mental condition by Waon therapy, and the effect continued throughout the observation period. In two patients, no improvement of symptoms was observed. Waon therapy brought the improvement in the score of Physical functioning(p<0.05), Role physical(RP)(p<0.05), Bodily pain(p<0.001), General health perceptions(p<0.03) and Role emotional(RE)(p<0.005) of FS-36 in good responders. However, the therapy did not bring any improvement in the score of Vitality, Social functioning and Mental health.   In poor responders, no improvement was observed in the score of FS-36. Mean duration of illness in poor responders was longer than in good responders (4.5±0.7ys:2.7±1.9ys, p<0.09). The performance state at the admission was almost same between poor responders and good responders (7±0:6.9±1.1). Conclusion: Waon therapy is effective for the treatment of ME/CFS. Although the present study included only 10 patients, the effects observed in our patients were dramatic. Further clinical studies in larger ME/CFS patient populations are required to confirm the effects of this method of treatment.

Background: Myalgic Encephalomyelitis/Chronic fatigue syndrome (ME/CFS) is an illness characterized by disabling fatigue. We examined the applicability of Waon therapy as a new method of fatigue treatment in patients with ME/CFS. Methods: Nine female ME/CFS patients (mean age, 38.4±11.2 years old; range, 21-60) who fulfilled the criteria of the Canadian clinical case definition of ME/CFS participated in this study. Patients received 30 sessions of modified Waon therapy, infrared-ray dry sauna maintained at an even temperature of 40°C or 45°C for 15 minutes twice a day for 3 weeks in a hospital, or once a day for five weeks at an outpatient clinic. Their functional health and well-being scores were determined using SF-36 and compared with those of six ME/CFS patients who did not undergo Waon therapy. Results: Seven of nine Waon therapy patients experienced a significant improvement in physical and mental condition, and the effect continued throughout the observation period. Waon therapy brought improvements in the scores of: Role physical (p<0.05); Bodily pain (p<0.05); General health perceptions (p<0.05); and Role emotional (p<0.05) of SF-36 in those who responded well (good responders) to the therapy. In two patients who responded poorly (poor responders) to Waon therapy, and in the non-Waon therapy patients, no significant improvement in the scores was observed. Conclusions: Waon therapy is effective for the treatment of ME/CFS.

1)Professionalism should be explicitly introduced as a fundamental content into curricula/programs of undergraduate medical education, postgraduate clinical training, and of continuing medical education provided by professional societies and the Japan Medical Association.
2)We need to enhance our research activities on goals and objectives which should be accomplished through professionalism education, effective learning strategies, appropriate assessment methods, as well as the impact of informal and hidden curricula.
3)We propose that the medical profession should collaboratively develop various activities to win the trust of the general society in tandem with the introduction of professionalism education.

OBJECTIVE: It is well documented that clozapine treatment causes agranulocytosis, but it can also induce drowsiness, constipation, and hypersalivation; however, these symptoms are usually less severe. It has been reported that clozapine-treated patients with schizophrenia and psychiatric healthcare professionals consider different side effects to be important. The aim of this study was to assess current practice related to the side effects of clozapine in clozapine-treated patients with schizophrenia and psychiatric healthcare professionals in Japan. METHODS: Data were collected from January 2014 to August 2015 in Okehazama Hospital, Kakamigahara Hospital, and Numazu Chuo Hospital. Clozapine-treated patients with schizophrenia and psychiatric healthcare professionals (psychiatrists and pharmacists) were enrolled in this study. RESULTS: Of the 106 patients and 120 psychiatric healthcare professionals screened, 100 patients and 104 healthcare professionals were included in this study. We asked the patients what side effects caused them trouble and we asked psychiatric healthcare professionals what side effects caused them concern. The patients and psychiatrists held similarly positive views regarding the efficacy of clozapine. The healthcare professionals were concerned about agranulocytosis (92.4%), blood routines (61.3%). On the other hand, the patients experienced hypersalivation (76.0%), sleepiness (51.0%). A positive correlation (R=0.696) was found between patient satisfaction and DAI-10 score. CONCLUSION: Patients experienced more problems than healthcare professionals expected. However, usage experience of clozapine healthcare professionals tended to have similar results to patients. It is necessary that all healthcare professionals fully understand the efficacy and potential side effects of clozapine. This is very important for promoting clozapine treatment in Japan.
Agranulocytosis ; Clozapine* ; Constipation ; Delivery of Health Care* ; Hand ; Humans ; Japan* ; Patient Satisfaction ; Psychiatry ; Schizophrenia* ; Sialorrhea ; Sleep Stages