First, as the assessor, Mr. Shuzo Yamamoto of the Assessment Section of the Japan Council for Quality Health explained (1) this assessment aims at the improvement in the quality of health care in the country, (2) the assessment items are set up to evaluate the system of an institution and what are practiced there, (3) those items are evaluated based on the documents submitted by an institution and by on-site assessment, and (4) the assessment intends to contribute to improving areas where there are deficiencies and not to accredit an institution.
Then, from the assessed side, the facility head and representatives of the clinical, nursing, and business sections stated that their difficulty with the assessment was to study how to improve what were in the assessment items, which were great in number and varied. They emphasized that they took the protection of the environment into consideration in their discussion. The facility head reported that the assessment helped to raise employees' awareness, but it would be difficult to maintain this level of awareness. The clinical section mentioned that despite the short period for preparation they formed a working group and all doctors worked together and it improved the situation immensely. The nursing section pointed to the importance of collaboration of the nursing section and all the other sections to improve their work by referring to Osaka National Hospital (National Osaka Medical Center) which was assessed twice. The business section reported the difficulty of acquiring sufficient budget to maintain a good working environment.
The symposium that followed can be summarized in the following two points. First, all present agreed that medical institutions are rightfully required to pass the assessment if they intend to offer quality medical services and they should continue to get assessed periodically. After the assessment medical institutions should set up a section to continuously grapple with the issues of improvement. Second, the number of national hospitals which have passed the assessment is fewer than other non-national medical institutions. It is hoped that more of them receive the assessment since even if some of the assessment items are unable to be improved due to insufficient facilities, if their efforts are recognized they will pass the assessment.

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The increasing societal demands for the establishment of pediatric emergency care have reached a critical point. Problems in pediatric emergency care are problems for all of pediatric medicine.
Issues for pediatric medicine in the past 10 years include the following: decreasing number of pediatricians working in public hospitals, aging and concentration of private clinic pediatricians in urban districts, the decreasing number of pediatric beds and closure of pediatric-only wards, poor reimbursement for pediatric care, etc. These problems are deep-rooted with complex interrelatio nships.
Societal factors, such as the following, further complicate resolution of these problems: the population structure in Japan greatly influenced by the extreme drop in birth rate and the highest longevity in the world, the increasing health care costs for the elderly, the collapse of Japanese economics, and national policy.
In this symposium, in addition to the above-mentioned problems, clarity was brought to issues such as the lack of clear policy to support the increasing number of female pediatricians, the difficulties in distinguishing primary, secondary and tertiary emergency medicine, and specialist-shopping by patients and their families and anytime-anywhere-cheap (convenience store type) medicine. Measures to address these problems include short-term actions which must be considered urgently, and long term plans which include the establishment of Pediatric Emergency Medical Centers in appropriately-sized districts.
By analyzing the present status of Japanese medicine, pediatric medicine, and pediatric emergency care, it is clear that organizational strategies and policies are needed. Now is the greatest opportunity for the National Hospital System to rebuild and prepare to address urgent issues.

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This symposium's aim is to question the need to prolong the existence of the National Hospital Attached Nursing School that will change over to an Incorporative Administrative Agency in April of 2004.
Although the number of nursing related schools has increased, the National Training Institution for Nurses that supplies nursing staff to institutions is struggling to secure sufficient nursing staff.
Therefore, the Health Policy Bureau Nursing Division advocates the necessity of the school because of the advantage to nursing care and medical services of having sufficient staff available.
In the present situation however, there are too many problems to meet because of legal conditions, so part of the problem is to be resolved by consolidation.
While determining the rationale for receiving public funds after incorporation is important, the most important role of schools is to provide students with a high quality education.
In this opportunity of changing over to a corporate organization, we obtained advice from five fields to contribute to measures to reform the 57-year-old National Nursing Education System.
Mr. Asamura made a suggestion to enhance nursing education including the operating rules for nursing schools and basic school laws based on the 57-year history of nursing education in National Nursing Schools.
Mr. Kimura offered information about the current situation of the management of his school that will help in the management of the Attached Nursing School after it is incorporated from next fiscal year.
Mr. Takahashi gave his opinion in regard to how to change the present situation with its many problems, which will help staff in the workplace to take appropriate actions.
Ms. Katsura, through her experience, recommended everyone be cooperative toward the realization of a full-time school principal responsible for the practical training in nursing care, which has been a long-time wish of hers.
Finally, Ms. Taniguchi, who is in charge of teaching clinical practice students, introduced ideas to keep in mind when considering nurse apprentices and student guidance in clinical practice.

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A sixty-three-year-old woman was brought to the hospital by ambulance, because of chronic convulsion and unconciousness after taking alcohol, cyanamide, and blotizolam. Upon admission, the patient showed alert conciousness and no chest pain. We found abnormal Q wave in V1-V3 and S-T segment elevation in II, III aVf, V1-V6 leads on her ECG. Acute myocardial infarction was primarily suspected and a coronary angiogram revealed no stenosis. However, the left ventriculography showed apical wall hypokinesis and basal hyperkinesis like “takotsubo” cardiomyopathy. At the same time she developed severe rhabdomyolysis and acute renal failure. But she recovered without aftereffect to her heart nor kidney.

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