Objective: This study aimed to identify the characteristics of cases in which walking level improves even in the later stages of convalescent rehabilitation, and to predict such cases.Methods: The Walking LEVEL Scale (WaLS) was measured over time in 192 patients (brain-related and orthopedic diseases) admitted to a convalescent rehabilitation ward. The “delayed recovery group (DR)” was defined as the group showing improvement of WaLS in the later period, while the “non-delayed recovery group (NDR)” was defined as the group for whom improvement of WaLS did not extend into the same period. Then, changes in WaLS over time and each factor were compared to identify differences between DR and NDR. Using receiver operating characteristic analysis, cutoff values, sensitivity and specificity, likelihood ratios for the relevant factors were calculated and examined for the predictability of DR utilizing Bayesian estimation.Results: WaLS temporal changes showed a sigmoid curve only in the DR of brain-related disease. Other groups showed logarithmic curves. The WaLS score at admission was selected as a significant variable. The positive and negative likelihood ratios for the score at cutoff values of 4 or less were 2.00 and 0.19 for brain-related disease, and 1.49 and 0.63 for orthopedic disease, respectively. Adopting the DR frequency of the participants in this study as the prior probability, the DR posterior probability of brain-related disease was calculated to be 5% using the negative likelihood ratio.Conclusion: The negative likelihood ratio of the WaLS score at admission is useful for predicting DR for brain-related disease.

Objective: This study investigated and compared the responsiveness of the Walking LEVEL Scale (WaLS), Functional Independence Measure (FIM)-walk item, and Functional Ambulation Category (FAC) in patients hospitalized in a Convalescent Rehabilitation Ward (CRW).Methods: One hundred three patients participated in this study. Physical or occupational therapists assessed the three scales at two times of admission and discharge to determine the responsiveness. The amount of change, ceiling and floor effect, Effect Size (ES), and Standardized Response Mean (SRM) determined the responsiveness to change from admission to discharge. Their analysis was by severity and disease.Results: The amount of change in WaLS was larger than that of the FIM-walk item and FAC, except for the moderate gait disability group. More ceiling and floor effects were observed in FIM-walk item evaluation. Regardless of severity or disease, all rating scales showed moderate or better responsiveness (ES > 0.5). When ceiling or floor effects were observed, ES tended to be overestimated. The SRM of WaLS was larger than that of the other scales, except for the mild gait disability group.Conclusion: The results support WaLS as the most suitable instrument to detect walking level changes over time for patients in CRW.

　　Using the results of a questionnaire survey, a study was made to ascertain whether or not the March 11, 2011 Great East Japan Earthquake influenced the attitude of survivors toward terminal illness and end-of-life care. The survey was taken one year after the devastating earthquake with the cooperation of 76 hospitals affiliated with the National Federation of Agricultural Cooperatives for health and Welfare. A total of 7,811 people ranging in age from 14 to 91 (M/F＝1/1.9) responded to the survey. They consisted of high school students, nursing school students, staffs of hospitals, and people with other types of occupation.　　Respondents from the two hardest hit regions (Fukushima and Ibaraki Prefectures: FIP) and three neighboring ones (Akita, Niigata and Nagano Prefectures: ANNP) were devided into the suffered and the non-suffered. The average suffering rate was 11% throughout the areas covered by the survey, which was compared with about 55% in FIP and 14-3.2% in ANNP.　　Analyses of sufferings of the respondents, broken down by age, sex, studentship and occupation, revealed that female sufferers outnumbered male sufferers and were younger in FIP than in ANNP. It was also found that female sufferers included many nursing students and medical staffs. A large number of male medical progessionals also fell victim to the quake.　　Interesting to note are the findings that a large number of male respondents from Fukushima and Ibaraki replied that they had religious faith, would prefer to be told the truth if they were terminally ill, had pondered over death, would like to see a man of religion when they realized their days were numbered, would desire the use of an optimum dose of opium to ease pain, and wished to deepen their knowledge of terminal illness. By contrast, more women than men said that they would choose to stay at home when they realized their days were numbered.　　These findings showed that the Great East Japan Earthquake significantly influenced the attitude toward terminal (care) with striking differences between men and women.

　　This paper deals with an analysis of responses to a questionnaire survey to look at the attitude of Japanese toward the problems involving telling the terminally ill patients the truth, palliative care and other related matters. The survey, designed to understand and treat the terminally ill patients properly, was carried out with the cooperation of 76 out of 114 hospitals affiliated with the National Federation of Agricultural Cooperatives for Health and Welfare.　　Effective responses came from 7,811 people (females/ males＝1.9 and age from 14 to 91). They consisted of high school students, nursing school students, hospital staffs and people with other occupations. Most of them were ready to join this study.　　Of the respondents, it was found, 21.0% of the respondents were religious people, 14.5% had seriously considered their own death, 2.4% wanted to live as long as possible even with a life-limiting disease, 26.0% wanted to be informed of the terminal illness generally, 76.4% wanted to be precisely informed, 34.5% wanted family members being informed on a terminal diagnosis, 27.5% wanted to be informed alone without the knowledge of the family members, 90.1% wanted to be informed by doctors in charge, but not by family doctors, 60.3% wanted the use of a proper dose of opium to alleviate pain, 67.3% wanted to use hospice care, 7.8% wanted to see a man of religion at the terminal stage of life, and 39.6% wanted to die at their own home.　　Significant differences were found in the response to the questions depending on their sex, age and occupations (high school students, nursing school students, medical persons or people with other occupations).　　The findings of 22 other large-scale surveys conducted between 1987 and 2012 showed that the ratio of those who did not like to receive the information on terminal (IT) decreased (from 30-40% to blow 1%), and that the ratio of those who wanted to be informed of their incurable illness increased (from 55-65% to 75-85%), thus indicating that IT seems to have being accepted widely in Japan.

　To improve hospital quality, the development of authorized clinical instructors is urgently needed. Therefore, we held a workshop to develop clinical instructors. At a monthly meeting of the clinical training committee in June 2014, an agenda for holding a workshop was proposed. At the meeting in July 2014, most committee members said they were reluctant to hold a workshop because of heavy clinical duties. However, the hospital president strongly suggested that a workshop might be a foundation for reforming the stagnated hospital and persuaded committee members to hold a workshop to improve the instructors’ skill in teaching residents. At the September meeting, the workshop schedule was discussed. All members of the taskforce, except the chief coordinator and a lecturer, were selected from hospital physicians, and 3 preparatory meetings and 1 rehearsal were held. With the help of administrative staff, our first workshop for clinical instructors was held at Daido Hospital in February 2014. Our workshop helped create new hopes for improving educational tasks at our teaching hospital and improved the educational skills of participants. We also achieved mutual understanding as a team to accomplish a single goal.

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.
2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.
3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.

[abstract in Japanese]
Pulmonary evaluation ; System ; Annual ; Human Development ; Health

[Objective] We performed a multi-center randomized controlled trial using sham acupuncture as a control in the 11 institutions of Aichi and Shizuoka prefecture at which we practice our original acupuncture method.
[Design · Methods] Patients were randomly allocated to four groups : A group, “Taikyoku-Ryoho” (whole body acupuncture method) pole treatment combined with low frequency electroacupuncture; B group, “TaikyokuRyoho” pole treatment; C group, low frequency electroacupuncture; D group, sham acupuncture. Therapeutic effectiveness was evaluated using a visual analogue scale (VAS) and criteria of the Japanese Orthopedic Association for low back pain (JOA score). After these evaluations, patients in B group received low frequency electroacupuncture and patients in C group received “Taikyoku-Ryoho” pole treatment. Patients in D group received both therapies. Thus, all patients eventually received the entire series of therapies. [Results] Significant improvement (P<0.05) in VAS and JOA scores was recognized after one acupuncture treatment in A, B and C groups, but not in D group. There were no differences in terms of the effectiveness among A, B and C groups.
[Conclusion] Our original acupuncture method of “Taikyoku-Ryoho” combined with low frequency electroacupuncture was superior to sham acupuncture. However, the definition of sham acupuncture needs to be more clearly defined in future research.

Eosinophilic gastroenteritis (EG) is characterized by infiltration of eosinophils into the wall of the digestive tract, and the clinical spectrum seems to depend on the predominant site of eosinophilic infiltration of the wall.
We experienced four cases of EG, and two of them (Cases, 1 and 2) manifested massive ascites, suggesting the principal lesion is located on the serous coat. Case 3 manifested abdominal pain and vomiting, and muscle layer involvement of the duodenum was detected by ultrasonography and CT scan. In case 4, epigastralgia was a main symptom. An endoscopic examination revealed marked redness and erosion of the gastric mucosa associated with massive infiltration of eosinophils. In this case, mucosal involvement seemed to be the main lesion because hypertrophy of the gut wall thickness was not found by ultrasonography and CT scan.
Although the pathogenesis of this disease is obscure, allergic mechanism may play an important role. Three cases had histories of allergic diseases, and steroid therapy resulted in prompt disappearance of symptoms.

Research on pulse diagnosis conducted so far by Kurono et al. includes a study on pulse diagnosis and six basic pulses and a study on the application of AMI (an apparatus for measuring the function of the meridian and corresponding internal organs) to pulse diagnosis.
In this study, fluctuation of the meridian functions with or without acupuncture treatment according to the law of the five elements were examined objectively using BP values measured by AMI. When BP values were measured for 10 times without acupuncture treatment, the values for the respective meridiansfluctuated in a stable manner, averaging 4% or less. As a result of testing 6 subjects using this meridian treatment according to the law of the five elements, fluctuation of the meridian functions increased in the oriental medical diagnosis of all the subjects.
Thus, the results of this study showed the feasibility of using AMI for objectively evaluating the fluctuation of meridian functions. The authors intend to continue to examine the relationship between diagnosis and acupuncture using AMI.