To provide material for a panel discussion entitled “The Image of the Female Physician Desired in the 21st Century” at the 28th Congress of the Japan Society for Medical Education, a survey was conducted on the present circumstances of female physicians practicing in Japan. The questionnaires were sent by mail to all 27, 779 female physicians residing in Japan who could be contacted. The rate of response was 29.5%. The results showed that more than 94% of female physicians currently work at institutions for medical services and that only 3.1% engage in works of basic medical research or work as public health administrators. The results also showed the necessity of providing better systems for the support of family life of female doctors to maintain their activities as precious human resources of society.

We investigated the current status and problems of cancer pain relief, sedation for cancer pain and uncontrolled symptoms in patients with recurrent gastric cancer. The subjects of this study were 59 patients with recurrent gastric cancer undergoing palliative treatment in the Department of Surgery of our hospital. We retrospectively examined the modality of cancer pain relief, use of sedation and the reason for sedation. Outpatient treatment lasted 0-682 days (mean ; 195.3 days) and hospitalization 1-117 days(mean ; 32.1 days). Nonsteroidal antiinflammatory drugs were used for all patients. Morphine was administered to 50 patients (84.7%). Analgesic effects were seen in all patients. No servere adverse events occurred. Sedation was used in 33 (55.9%) for general fatigue (28) and/or restlessness (17). We concluded that analgesia was sufficient and safe with nonsteroidal antiphlogistic and pharmaceutical morphines, but about half of the cases required sedation.
cancer pain ; Sedation procedure ; Gastric cancer recurrent ; therapeutic aspects ; symptoms <1>

Objectives: The reliability of surveys on smoking habits based on questionnaires was investigated, using the urinary cotinine content as an objective index. Methods: The subjects tested were 2,849 office workers of middle age, who responded to questions concerning their smoking status, and also their urinary cotinine was measured by the HPLC method. Results: The boundary value between smokers and non-smokers, determined by the histogram independent of the questionnaire, was 63.1 and 79.4 ng/mg of creatinine for males and females, respectively. The rate of misclassification of the non-smokers and former smokers as smokers was 1.3% for males and 1.8% for females, whereas that of current smokers as non-smokers was 6.3% and 2.1%. We also assessed the effect of smoke inhalation on the urinary cotinine value, and found a significant difference for males in the cotinine value by the presence of inhalation and also its depth. Conclusions: The rate of misclassification in this study was considered to be comparatively low. Several studies have also assessed the reliability of the questionnaire on smoking habits, and found different misclassification rates, indicating the dependence on the race and number of subjects tested. To our knowledge, there were only a few surveys on smoking among large groups, particularly in Japan, such as this one, therefore the results obtained in this study are meaningful.
Smoking ; Cotinine ; Indexes ; seconds ; Urine

Introduction : We evaluated the efficacy of daisaikoto for patients with generalized fatigability or easy fatigability by multiple regression analysis.Subject and Methods : The subjects were fifty-three patients with generalized fatigability or easy fatigability, consisting of 6 males and 47 females, mean age 38 y/o (range 23-72), who were treated with daisaikoto according to Sho for more than one month. The relationships between the improvement of generalized fatigability or easy fatigability and 46 factors, including age, sex, height, body weight, hypertension and other symptoms noted at the first medical examination, were examined by multi-dimensional cross-sectional analysis.Results : The factors of sweating, hot flushes, sensation of something stuck in the throat, and feeling of fullness in the chest were significant. Improvement of objective tenderness on the sides of the abdomen and sweating formed the best subset of explanatory variables.Discussions : The sensation of something stuck in the throat and feeling of fullness of the chest often occur under Ki stagnation. The improvement rather than the existence of objective tenderness on the sides of the abdomen is assumed to be more important factor.

Introduction : We evaluated the efficacy of keishito and maobushisaishinto with reference to keikyososooshinbuto, for patients feeling cold, by means of multiple regression analysis.
Case reports : We reported a patient with an upset stomach whose severe coldness was improved as the stomach condition was cured by adding keishito to maobushisaishinto. Moreover, the combination of keishito and maobushisaishinto was effective for a patient feeling cold, with appetite loss, general fatigue and stiffness of the joints (case 1), a patient feeling cold, with chill, general fatigue, heavy feeling in the stomach, and prone to catch colds (case 2), and a patient feeling extremely cold, with general fatigue and menstrual pain (case 3).
Subjects and Methods : In this study, the subjects were 43 patients who reported feeling cold. They were treated with keishito and maobushisaishinto according to their Sho for more than one month. The relationships between the improvement of cold sensation and 52 other factors, such as symptoms noted at their first medical examination, were evaluated by means of multi-dimensional cross-sectional analysis.
Results : The factors of chilly or unpleasant wind and coldness of the whole body were significant.
Discussion : The factors of coldness in the whole body with chill, and headache without diarrhea were important for improvement of cold feeling with keishito and maobushisaishinto.

Periodic evaluation of end-of- life (EOL) palliative care is important to maintain and improve quality of EOL palliative care. We conducted a cross-sectional, anonymous, self-report questionnaire survey for bereaved family members of cancer patients in 2010. This was the second time nationwide survey. This study aimed to evaluate EOL cancer care from the perspective of bereaved family members in nationwide general hospitals, inpatient palliative care units (PCUs), and home hospices in Japan and to explore whether there is any change of quality of palliative care over the last nationwide survey conducted in 2007. Among member facilities of Hospice Palliative Care Japan, 25 general hospitals, 103 PCUs, 14 clinics participated in this study and 7797 bereaved family members answered the questionnaire. Overall, bereaved family members were satisfied with EOL care in all places of death, as in the last survey. Although results indicated that coordination of care and physical care of nurse were warranted to improve in general hospitals, drawback of PCUs were availability and the potential deficits of clinics were the environment. Through the years, there is no clinically significant change from the last survey. We should continue to make efforts to evaluate and monitor palliative care in Japan for quality control.

Understanding the symptoms of the general population has an important role in assessing and improving the quality of palliative care systems. However, there are no reliable epidemiological data on the symptoms of the general population in Japan. The aim of this study was to survey the actual status of the symptoms experienced by the general population in Japan. A large nationwide postal survey was conducted from January through February 2013 in Japan. A total of 2400 subjects were selected randomly from among members of the general population who were 20 to 79 years of age and lived in Japan. The Memorial Symptom Assessment Scale (MSAS) was used to multi-dimensionally evaluate symptoms experienced within the past week, and the Short Form 8™ (SF-8™) was used to assess the health-related quality of life (QOL). A total of 978 (41.1%) self-completed questionnaires were analyzed. The prevalences, severity rates, and distress rates of 35 physical and psychological symptoms were analyzed according to sex and age group. In addition, the relation between symptom severity and the health-related QOL score was evaluated. From the perspectives of public health and administrative policy, the results of this survey will most likely provide important basic data, with the ultimate goal of establishing a palliative care system in Japan.

We evaluated the efficacy of yokukansan-based prescriptions for patients with headache. Forty-five patients with headache (34 migraine, 6 tension-type, and 5 combined headaches), or 6 males and 39 females, mean age 38 (25 to 68) years were treated with yokukansan-based prescriptions according to their Sho diagnosis, for 1 to 24 months. Relationships between headache improvement, and 31 factors including age, sex, height, body weight and other symptoms at first examination, were qualified with multi-dimensional analysis. Factors such as painful eye sensation, back stiffness, eyestrain and irritability were significant indicators of headache improvement. Three of these factors (painful eye sensation, back stiffness and irritability) were the best subset of explanatory variables. Yokukansan-based prescriptions seemed to be effective for “liver-related” headache, and were thought to be useful to relieve a triggering or worsening of headache factors. And to our knowledge, this is the first paper to propose the importance of examinations of the back, when considering yokukansan-based prescriptions.
Headache ; Back ; Therapeutic procedure ; Esthesia ; Prescriptions

We evaluated the efficacy of chotosan for headache patients via multiple regression analysis. The subjects were 46 patients with headache (31 migraine, 14 tension-type, and1combination headache), consisting of 1 3males and 33 females, mean age 48 years (range 19-77 years), who were treated with chotosan according to their Sho (symptoms) for more than1month. The relationships between the improvement of headache and 38 factors, including age, sex, height, body weight, hypertension and other symptoms noted upon first medical examination, were examined through multi-dimensional cross-sectional analysis. Morning headache, dizziness, insomnia, body weight, tinnitus and vasodilatation of sublingual veins were significant factors. Morning headache is traditionally an indication for the use of chotosan, and our results support its efficacy for this purpose. Three factors, i.e. morning headache, vasodilatation of sublingual veins and stiff shoulder, were the best subset of explanatory variables. Stiff shoulder is a key symptom for the application of chotosan, while stiffness in the back is a key symptom for the application of yokukansan.
Headache ; symptoms <1> ; multiple regression ; Analysis ; Pulmonary evaluation

Objectives: Primary aim of this study was to clarify the family evaluation about caring the body of the deceased patient by nurses at Japanese inpatient hospices and palliative care unit. Method: A mail survey was performed on 958 bereaved family members of 103 palliative care units in July, 2010. Result: A total of 597 family members replied（62％）. As a whole, 441（74％）families reported that they were satisfied with the way caring the body of the deceased patient by nurses. A multivariate analysis revealed three factors were significantly associated with the levels of satisfaction:the patient face became peaceful and calm, and nurses treated the patient in the same way before died, and patient age was over 70 years old. Conclusion: Making patient face peaceful and calm, and treating the patient in the same way before died is important in caring the body of the deceased.