With the coming of an aging society in mind, the author used Japanese medicine together with Western medicine to examine the effectiveness in the case of elderly persons.　　Cases of BPSD (behavioral and psychological symptoms of dementia) (ten persons), depressive symptom (ten persons), sleep disorder (ten persons), gait disturbance (ten persons), constipation (ten persons) and aspiration pneumonia (ten persons) were examined.　　Fifty-five persons out of sixty effectively responded to the East-West combined therapy.　　Team medical care was needed. It is required for the hospital to provide doctors and paramedics with a full-scale training course in Japanese Kampo medicine.

　　The present author reports here two cases which showed a strong possibility of the occurrence of cerebral hemorrhage upon a visit to our outpatient clinic. Case 1 was a regular female patient aged 85 years. Her blood pressure had been elevated to somewhere around 200 systolic. At the time of clinical examination, her blood pressure reading was 168/96 mmHg. Edema was found in the dorsum of foot which was flushed generally. On the following day, she was admitted to hospital with cerebral hemorrhage. The swelling and flush were gone soon after hospitalization. Case 2 was a 73-year-old man. He had been under treatment for diabetes, hypertension and hyperuricemia for more than 10 years. The man was hospitalized with a decreased level of consciousness due to cerebral hemorrhage. His blood pressure was 191/98 mmHg. A change in appearance of his feet, which had been found in the outpatient clinic of the internal medicine department was not noticed one day after hospitalization.　　We thought that, together with high blood pressure, the swelling of feet as seen in our two cases might be a premonitory symptom of cerebral hemorrhage. To prevent cardiovascular events, our cases will provide plenty of food for thought. So, in this report, the author will discuss these cases while making reference to some previous studies.

　　The team organized by a diabetologist, a pediatrician, a nationally-registered dietitian, a midwife, a child care worker, a nurse and a physical therapist worked out the concept for a better living support center involved themselves in the establishment of a livelihood betterment center which would evolve around a facility to practice cooking. A mother-and-child support center, a health control support center and a rehabilitation center were set up so that those facilities could be spatially tied in with a support center for improvements in the lifestyle, thereby making it feasible to unfold measures to combat lifestyle-related diseases. The system which centers on the facility to practice cooking presumably made it possible to make progress from “spatial coordination” to “functional coordination.” With this system, it has become feasible to evolve a wide variety of measures in the sectors of health care, medical care and welfare for not just the sick but also people good in health. It is important for hospitals in the future to make contributions in the sectors of health, care and welfare. The system we have discussed here may well serve as a model for contributions by hospitals to their communities.

　　The present study was conducted to shed light on the fact about mental health care for the staff in a general hospital. It is well-known that hospital doctors and nurses suffer from high levels of stress.　　Early detection of worries and concerns of workers is important in mental health care. The improvement of mental health and prevention of stress-related disease should be considered according to the occupational category. There are few hospitals which have the specialists in mental health care for the staff.　　It is helpful to use unique support tools for encouraging employees in to recognize what causes them to feel stressed and understand problems that come from their environment.　　Over the period of 10, we have practiced mental health care for the hospital staff.　　We report the results of our efforts.

We examined 375 patients who were administered Kampo medicine for emergency hospitalization in the acute period ward for 6 years and to improve early illness and symptoms. There were many significant uses of hozai. Of the top 5 types of Kampo medicine administered, 4 were hochuekkito, ninjinyoeito, rikkunshito, and daikenchuto. In the case of emergency hospital admission, it was considered that there were many uses of hozai for poor oral intake, walking disorder, and low level of consciousness, among others. Next, there were many risuizai uses.

This is a case report of Graves' disease. The patient was 76-year-old female. She was hospitalized for acute subdural hemorrhage immediately after onset of Graves' disease with liver injury. It was difficult to treat her with Western medicine because of the potential side effects of the drug. So we prescribed shakanzoto. Thyroid hormone levels, TRAb levels and physical symptoms were all improved. Psychological symptoms were also improved. This suggests that Graves' disease can be improved by Kampo medicine when Western medical treatment is difficult.

Diabetic foot lesions are internationally defined as infections, ulcers, or destructive lesions of the tissue of the lower extremities in patients with diabetes associated with neuropathy and peripheral artery disease. Early treatment is necessary for the three main causes of diabetic foot disease : neuropathy, peripheral artery disease, and infection. In this study, based on these associated factors, Kampo medicine was found to be effective for foot lesions in 50 to 100% of the 13 outpatients and 4 inpatients with diabetes. Kampo medicine treatment was effective for 50% or more patients with diabetes and neuropathy. In peripheral artery disease, Kampo medicine improved the circulation ; in particular, tokishigyakukagoshuyushokyoto improved the ankle-­brachial pressure index. In patients with diabetes and infection, hozai improved the general condition in combination with antibiotics of Western medicine.

　　Evaluation of the attitude of patients according to behavior modification stage when they were admitted to hospital for our diabetes educational program and various parameters after they discharged were reviewed.　　We examined the 106 people (53 males and 53 females, average age 66.0 years) who were admitted to our hospital for diabetes education during the period from October 2009 to February 2012. We examined HbA1c levels and measurements taken during the stay in hospital, and 1 month, 3 months, 6 months, 9 months, and 12 months after leaving hospital. Compared with the measured values in the hospital, HbA1c levels measured each month showed a significant improvement (p<0.05). By evaluation of the value according to behavior modification stage, we recognized a rebound tendency in precontemplation groups. The evaluation of patients’ attitude by occupation according to stage of behavior modification revealed a difference more than 2 stages by approximately 10%. From these result, it was speculated that the patient self-management skills made a significant impact on glycemic control after hospital discharge.　　Diabetes educational hospitalization is supported by team members who vary in specialty. It is expected that we can provide higher-quality medical care by each specialist and supporter with a good knowledge.　　Assessment difference of behavior modification stage may appears by each specialty staff member and by changes in physical condition and feeling of the patients. In addition, these causes may change further by difference in the way each specialist deals with the patients. Therefore, we considered it was important to share information and have the mutual confirmation of the evaluation. Now, team medical care is regarded as important. It was suggested that cooperation among the staff members would lead to better medical treatment, and to improvement in patients’ QOL.

　　It is said that diabetes is one of the factors contributing to the onset of dementia and accelerating its progression. The number of dementia cases is expected to increase steadily year by year. Such being the circumstances, we encountered an elderly woman with diabetes and dementia, who managed to lower her blood glucose values to a proper level somehow or other, thus lightening the burden of caregivers. We shall hereby report the case because we thought it would make a good example for care in the region where the population is rapidly graying. The woman, then at age 80, visited our hospital complaining of languidness. Her blood sugar level was so high (random blood glucose level: 1,096 mg/dl) that she was hospitalized at once. By a stepwise insulin reinforcement therapy, the blood glucose levels were under control. During the stay in hospital, she was also diagnosed as having senile dementia. She was provided with effective health care and education for the control of blood sugar levels. Having snacks between meals was strictly prohibited. Considering that she was an elderly person living alone, only internal medicines were given. As a result, her blood glucose levels were elevated to about 300 mg/dl, but the combined use of GLP-1 injection and internal medicine once a week had good control over blood glucose levels. So, the patient was discharged from the hospital.

　　A 63-year-old woman was admitted with complaints of thirst and polyuria about 1 year after ceasing therapy in November, X and in October, X+1. Her blood glucose levels at the beginning of her admissions were 347 at the first admission and 486 at the second admission. We administered glargine, a long-acting type insulin, 8U/day, and　a short-acting insulin, glulisine, 4U/day, during the first admission. We administered glargine, a long-acting type insulin, 4U/day, and a short-acting insulin, glulisine, 3U/day, during the second admission. We also administered a GLP-1 receptor agonist, liraglutide, 0.3mg/day. Blood glucose levels (mg/dl) during the 5 days of the first admission were as follows: first, -, -, 347, and 180; second, 273, 266, 109, and 188; third, 75, 192, 186, and 182; fourth, 93, 194, 91, and 144; fifth, 78, 95, 124, and 127. In the second admission, blood glucose levels were as follows: first, -, -, 486, and 299; second: 140, 137, 195, and 128; third: 101, 122, 114, and 108; fourth: 101, 123, 123, and 137; and fifth, 89, 136, 111, and 129. CGM data showed an average of 128mg/dl and standard deviation of 34 during the first admission. CGM data showed an average of 125mg/dl and standard deviation of 20 during the second admission. The reduction of insulin and rapid flattening of blood sugar were achieved by GLP-1 receptor agonist with promotion of insulin secretion and suppression of glucagon secretion.