To educate patients with diabetes mellitus, we use a clinical pathway. Pharmacists hold the chair of instruction on the use of drugs and insulin self-injection during the course of the pathway. Until now, teaching contents have been left to discretion of attending pharmacists. Therefore, we draw up a brochure to set standards for instruction.　　By using this brochure, it has become possible to instruct patients without relying only on the knowledge and experience of pharmacists in charge. Additionally, we have become able to share teaching contents of pharmacists with nurses.　　By publishing the brochure, intervention of pharmacists in the pathway has become smoother. For better and more efficient instruction on the use of drugs in a limited time frame in the clinical pathway, we need to overhaul of the brochure and to develop a method to evaluate patient’s understanding.

Objective : To translate the Abbreviated Neighborhood Environment Walkability Scale into Japanese (ANEWS-J) and to examine its reliability.Methods : One hundred sixty three community residents (male: 38.7%, age: 21-69 years old) of 600 who were randomly selected from the registry of residential addresses of Taitoh Ward in Tokyo and Fujinomiya City in Shizuoka Prefecture, responded to mail survey including ANEWS-J. Seventy-seven of 163 answered same questionnaire twice with ten days interval to examine the test-retest reliability.The questionnaire was translated into Japanese and fixed through the processes of preliminary test, backtranslation into English and discussion with authors of original version.Intraclass correlation coefficients (ICCs) were calculated for the evaluation of reliability of ANEWS-J.Results : ICCs of the eight subscales of ANEWS-J were residential density; r=0.95 (95% confidence interval; 0.93-0.97), land use mix - diversity; r=0.96 (0.94-0.98), land use mix - access; r=0.90 (0.84-0.94), street connectivity; r=0.83 (0.74-0.90), sidewalk / bike lane; r=0.82 (0.71-0.89), aesthetics; r=0.85 (0.76-0.91), traffic safety; r=0.81 (0.70-0.89), crime safety; r=0.76 (0.62-0.86).Stratified analyses by gender and residential district showed satisfactory reproducibility of the subscales (r=0.63-0.97). Conclusion : Acceptable reliabilities of all eight subscales of ANEWS-J were confirmed in this study.

Background: Perceived benefits and barriers to exercise are important correlates of exercise participation. Purpose: To develop a short version of the perceived benefits and barriers to exercise scale and to examine its validity and reliability. Methods: A population-based cross-sectional study of 865 participants (age: 20-69 years old, men: 46.5%) was conducted in four cities in Japan (Koganei, Tshukuba, Shizuoka, Kagoshima). Perceived benefits and barriers scale including five benefit subscales (physical benefit, psychological benefit, social benefit, weight management, self-improvement) with 10 items, five barrier subscales (discomfort, lack of motivation, lack of time, lack of social support, poor physical environment) with 10 items and stage of change for exercise behavior were assessed by self-administered questionnaire. Results: Confirmatory factor analyses to examine the construct validity revealed acceptable fit indices (benefit scale: GFI=.980, AGFI=.951, RMSEA=.058, AIC=151.669, barrier scale: GFI=.973, AGFI=.949, RMSEA=.060, AIC=166.084). Seven of ten subscales indicated significant linear associations with stage of change for exercise behavior, criterion-related validity was revealed. The reliability of the scale was found to be good as internal consistency and inter-rater reliability. Conclusion: The short version of the perceived benefits and barriers scale developed in this study demonstrated acceptable construct validity, criterion-related validity, internal consistency and inter-rater reliability.

It has been experienced that Kampo, with its philosophy that every disease is psychosomatic in origin and that herbs affect both the psyche and the soma, sometimes has a dramatic effect on somatoform disorders, though there has been no study examining the effects of Kampo on somatoform disorders. In this preliminary study, the morbidity of somatoform disorders among patients who visited the Keio Kampo Clinic and the patients' psychological well-being were examined.
One hundred patients (17 males and 83 females; mean age [±SD], 39±16) who sought Kampo treatment for the first time at Keio University Hospital participated in this study. A Japanese checklist derived from the somatoform disorders schedule (version 1.1) was used to check the somatoform symptoms. To assess psychological well-being, the subjective well-being inventory (SUBI) was performed. The subjects' clinical records were examined afterwards to rule out symptoms which could be medically explained.
Somatoform patients and medically ill (non-somatoform) patients were 65% and 26% of the total respectively. The somatoform patients showed significantly lower SUBI positive scores than the non-somatoform patients (p=0.042), while SUBI negative scores were significantly higher (p=0.001). Among the somatoform patients, there was a negative correlation between numbers of somatoform symptoms and SUBI positive scores (r=0.267; p=0.032), and a positive correlation between numbers of somatoform symptoms and SUBI negative scores (r=0.337; p=0.006).
Following the SUBI scores through treatment courses may lead to a better understanding of the pathology of somatoform disorders and to more effective use of Kampo.

Frontotemporal dermoid cysts with a cutaneous sinus tract in the sphenoid bone are rarely found, and furthermore, the spreading of these cysts across the frontal branch of the facial nerve has not been reported. Herein, we present a 5-year-old case of a dermoid cyst successfully resected with preservation of this nerve using a combined extracranial and intracranial approach. This approach is recommended for a safe and radical resection of the lesion and for securing an aesthetic outcome.
Child, Preschool ; Dermoid Cyst ; Facial Nerve ; Humans ; Skull ; Sphenoid Bone

The usage of Kampo medicine has been expanding in hospitals and pharmacies, and the systematic education on Kampo medicines and their components is urgently needed. Although the efficacies of Kampo formulations are approved at the national level, those of the composing crude drugs are not approved individually except for some cases. Consequently, the efficacy description of individual crude drug in textbooks differs much depending on the authors. To clarify this situation, we suggested the standardized description of the efficacy of crude drugs used in ethical Kampo formulation using terms of modern Western medicine in the previous study. In this study, we reviewed the descriptions of efficacies using the terms of Kampo medicine in the books published in Japan from the 17 century to the present to explore the possibility of standardizing the crude drug efficacies using the terms of Kampo medicine. The proposal for standardized description of the efficacy of crude drugs was based on the high frequency of appearance of the terms in successive books.