OBJECTIVE: To demonstrate the feasibility of webinars, web-based real time interactive seminars, for geographically distant medical students and their tutors.
METHODS: Six participants from 5 medical schools in Japan were self-selected 3rd to 6th year medical students. A North American medical educator served as their webinar tutor. The students and tutor used home computers to participate in the webinar.
RESULTS AND CONCLUSIONS: A total of twelve webinars were held, 4 with a tutor and 8 without the tutor. Unstructured tutoring formats included symptom-related differential diagnoses, role-play and patient case discussions. We suggest webinar is a feasible technology to supplement the clinical training of medical students at medical universities.

OBJECTIVE: To demonstrate the feasibility of webinars, web-based real time interactive seminars, for geographically distant medical students and their tutors.
METHODS: Six participants from 5 medical schools in Japan were self-selected 3rd to 6th year medical students. A North American medical educator served as their webinar tutor. The students and tutor used home computers to participate in the webinar.
RESULTS AND CONCLUSIONS: A total of twelve webinars were held, 4 with a tutor and 8 without the tutor. Unstructured tutoring formats included symptom-related differential diagnoses, role-play and patient case discussions. We suggest webinar is a feasible technology to supplement the clinical training of medical students at medical universities.

Purpose：Chronic cough is one of the symptoms that lead to a reduction in the quality of life insomnia, such as the decline in physical strength. For chronic cough due to metastatic lung tumors, and we experienced an example of after use pregabalin, showed a reduction of symptoms. Case：This case is a 75-year-old man. Abdominoperineal rectal amputation was performed in rectal cancer. Adjuvant chemotherapy has been performed, but multiple lung metastases appeared one year after surgery. Chemotherapy was continued, but lung metastases progressed, it became the policy of anti-cancer treatment ended 4 months after 2 years after surgery. Cough worsened since then, it was referred introduced to palliative care department. Because we thought respiratory tract irritation increased by organic disease is the cause, it starts from 50 mg／day pregabalin, it was increased by 25～50 mg while aware of potential side effects, such as drowsiness during the day. Cough relief at 125 mg／day, night sleep wasalso secure and possible. Conclusion：Pregabalin which is effective in neuropathic pain, there is a possibility that the suppression of hyperexcitability of nerve cells that are its pharmacological action, is also effective in chronic cough, it becomes choice of antitussive different mechanisms of action and opioid there is a possibility that may.

Objective：There are few reports on decision-making support at palliative care clinics in designated regional cancer care hospitals. This study clarified the types of decisionmaking support patients with cancer and their families were provided by specialized outpatient palliative care services. Method：We retrospectively examined the medical records of 110 patients who had been referred to the palliative care clinic for home care between April 2012 and March 2014. Results：The median duration of receiving services from the palliative care clinic was 23 days（range：1～492 days）. The mean number of visits to the clinic was 4.7 visits（range：1～29 visits）. A total of 89 patients（80％）needed decision-making support. Of those 89 patients, 33（30％）required support in making a decision about anticancer treatment. Twenty-six（78％）of those 33 patients had just received the diagnosis or were receiving anticancer treatment. Conclusion：The study suggested that decision-making support in early stages is an important role for a palliative care clinic in a designated regional cancer care hospital.

BACKGROUND: The facial expression of medical staff has been known to greatly affect the psychological state of patients, making them feel uneasy or conversely, cheering them up. By clarifying the characteristics of facial expression recognition ability in patients with Lewy body disease, the aim of this study is to examine points to facilitate smooth communication between caregivers and patients with the disease whose cognitive function has deteriorated. METHODS: During the period from March 2016 to July 2017, we examined the characteristics of recognition of the six facial expressions of "happiness," "sadness," "fear," "anger," "surprise," and "disgust" for 107 people aged 60 years or more, both outpatient and inpatient, who hospital specialists had diagnosed with Lewy body diseases of Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies. Based on facial expression recognition test results, we classified them by cluster analysis and clarified features of each type. RESULTS: In patients with Lewy body disease, happiness was kept unaffected by aging, age of onset, duration of the disease, cognitive function, and apathy; however, recognizing the facial expression of fear was difficult. In addition, due to aging, cognitive decline, and apathy, the facial expression recognition ability for sadness and anger decreased. In particular, cognitive decline reduced recognition of all of the facial expressions except for happiness. The test accuracy rates were classified into three types using the cluster analysis: "stable type," "mixed type," and "reduced type". In the "reduced type", the overall facial recognition ability declined except happiness, and in the mixed type, recognition ability of anger particularly declined. CONCLUSION There were several facial expressions that the Lewy body disease patients were unable to accurately identify. Caregivers are recommended to make an effort to compensate for such situations with language or body contact, etc., as a way to convey correct feeling to the patients of each type.
Aged ; Aged, 80 and over ; Cluster Analysis ; Cognition ; physiology ; Emotions ; Facial Expression ; Facial Recognition ; physiology ; Female ; Humans ; Lewy Body Disease ; physiopathology ; psychology ; Male ; Middle Aged