Introduction: The aim of this study was to consider the definition of solitary death by examining characteristics of cases, and to explore the impact of the coronavirus pandemic.Methods: Subjects were individuals with post-mortem examination and autopsy imaging data recorded between 2017 and 2022. Subjects were classified by whether they passed away at home (solitary). We investigated differences between groups in their causes of death, time elapsed between death and discovery, presence or absence of housemates, and prior symptoms.Results: There were 129 cases (79.9%) of solitary death and 41 cases (24.1%) of death outside the home. Solitary death cases were significantly younger. Among these, less than half were discovered more than a day after death, lived alone, or were older adults. Older adults and those discovered more than a day after death were more likely to have trauma as their official cause of death. The frequency and characteristics of solitary death did not change before or after the coronavirus pandemic.Conclusion: Preventive measures for solitary death should not be limited to older adults or those living alone. In particular, deaths from diseases other than sudden death, trauma in older adults, and cases where symptoms were present or medical attention was sought before death are potentially preventable. Countermeasures for solitary death are important in the post-coronavirus pandemic period.

We four medical students (one in the 2nd year and three in the 3rd year) visited Thomas Jefferson University in Philadelphia for 2 weeks during spring vacation. We audited classes to study differences in medical education and visited the hospital to observe common medical practices in the United States. Because of this experience, we started to rethink medical care in Japan as well as our future commitment to medicine.

Introduction : The purpose of this study was to approach issues related to end-of-life care by investigating elderly people's own thoughts about surrogate decision making by family members.
Methods : Semi-structured interviews were carried out with 30 elderly people 60 years of age and older to determine whether or not they trust in surrogate decision making by their family members, and to examine the reasons for their thoughts. Each of the respondents' statements were categorized by level of confidence, and their reasons were analyzed.
Results : Respondents were divided into two main groups : a “trusting” group and an “anxious” group. Seventy percent of respondents were in the “trusting” group. In both groups, the most common reason given was related to the desire to directly communicate one's wishes to one's surrogates. Following that, in the “trusting group”, the main reasons were related to the thoughts of the interviewee and the characteristics of the surrogates. In the “anxious group”, the main reasons were issues of end-of-life care related to the feelings of surrogates, the attitude of medical staff, and other background factors.
Conclusion : To resolve issues of surrogate decision making related to end-of-life care, it is important in primary care practice to provide encouragement and support to elderly people to allow them to clearly communicate their wishes. We recommend further study and ethical discussion about end-of-life care to establish appropriate legal and institutional frameworks.

Introduction: The purpose of this study is to elucidate the influence of drugs on infants and to provide information about safe drug treatments during breastfeeding using the FDA’s Adverse Event Reporting System (FAERS).
Study Design: Case series based on FAERS data.
Methods: We used the cleaned FAERS data in JAPIC AERS, extracted cases of adverse events from the category “neonatal exposure through breastfeeding (2000189)” in Standardized MedDRA Queries, and collected “the cases of breast-feeding infants” by system organ class, the type of adverse event, therapeutic category of first suspected drugs, and the generic name of the drugs.  We aggregated the data of the most reported cases of suspected drugs from first to fifth by the name of the adverse event.  Additionally, we investigated the properties and disposition of each suspected drug and verified the transitivity of breast milk as well.
Results: Only 551 cases of breast-feeding infants (0.01%) were extracted from the data of JAPIC AERS.  The aggregated data of adverse events in terms of system organ class showed high numbers of gastrointestinal disease (such as diarrhea and vomiting) and impairment of the nervous system (such as drowsiness), and drugs which acted on the nervous system were the most suspected drugs.  There were 26 cases of adverse events associated with lamotrigine, which was the most frequently reported.
Discussion: We could observe the characteristics of adverse events and suspected drugs that were shown as the influence of drugs taken during breastfeeding which were exposed to infants.  Our study showed 2 conclusions: 1) the drugs that have had adverse events frequently reported have the characteristic of facilitating the drug’s migration into breast milk, and 2) the most frequently reported cases were those in which nursing mothers or medical experts could recognize the correlation between breast milk and the adverse event(s) immediately after breast milk was given to the infant.