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.

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　　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.

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　　From 2008 to 2014, we experienced 40 respiratory failure cases which required long-term ventilation in the post-ICU in Kakeyu Hospital. They had been referred to our hospital from acute care hospitals and most of them had been transferred on our regional medical cooperation system. Initially, we used long-term care beds for them, but as the number of serious cases increased, we moved them to acute care beds. As regards main causes of respiratory failure, post cardiac arrest syndrome topped the list with 12 cases, followed by chronic obstructive pulmonary disease, intractable neurological diseases and cervical cord injury. All these cases combined, the number came to 30 cases, accounting for 75% of all. The shortest stay in hospital was made by a patient with brain stem lymphoma. It was only 12 days, but the longest was made by a patient with post meningoencephalitis 6 years. Our care consisted not only ventilation and medical care but also giving a bath, walking with a type of wheelchair, and sunbathing at the rooftop of our hospital. In May 2014, we renovated the post-ICU from an acute care division to a physical disability patient ward. As the elderly population will increase, it is expected that the need for acute care will augment in parallel with an increase to the number of post cardiac arrest syndrome and the demand of long-term ventilation. Therefore, the community care system will need the post-ICU for cooperation with acute care hospitals.

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　　Sales of cut flowers depend much on outside appearance. They are not supposed to be, so pesticide is used more liberally for cut flower growing than for other agricultural products. When the annual group health checkups for cut-flower farmers were held in late-August in 2009, 2010, 2011, we sampled spot urines and measured four dialkylphosphates, the metabolites of the organo-phosphorous pesticide. 　　At one time, concentrations of dimethylphosphate in 2 males were around 1,000-fold as much as the median of this group. Their serum cholinesterase activity levels at that time declined to 64% and 72% of their average measurements in the other years. These figures were comparable to the level that the pesticide spraying procedure should be revised, as suggested by the agricultural worker health system in California, United States which monitored cholinesterase activity levels in farmers. 　　We had interviews with the two Japanese cut flower growers. One of them complained of unbearable cough with pyrethroid insecticide spraying. We advised him some measures in consideration of his history of respiratory disease. He decided not to use pyrethroid insecticides. Another man refused to talk about the pesticide exposure risk at first. But later on, we heard that he had decided to wear dust protective mask. 　　The risk communication using the measurement of the index of pesticide exposure seemed to be a effective way to decrease pesticide exposure and its adverse effect. Although this procedure needs some trained interviewers and is sometimes refused by farmer, we are going to continue this type of dialogue from now on.

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　　With the aim of revamping hospital service as a pillar of our hospital reform movement, the Service Training Committee came into being in 2012. 　　A questionnaire survey was conducted on the entire personnel and tenant suppliers (the entire personnel, tenants and contractors’ employees?). About 80% (705 people) of those queried replied. More than 90% of the respondents were of the view that an improvement in the manner of reception should enhance not only the prestige of the hospital, the evaluation its medical treatment and patients&rsauo; degree of satisfaction, but also hospital employees’ degree of satisfaction and their quality of life. 　　On the other hand, some respondents said that there was much to be desired in the way hospital employees exchange greetings with their colleagues and in the manners or the language they use when they speak to patients. 　　Most of the hospital staff seemed to understand the importance and meaning of service and hospitality very well. It was clear that the hospital employees were willing to join in our drive to improve the quality of service. They also understood the problems they should address to in earnest. 　　We thought it was our task to make use of their positive attitude toward the quality improvement of service. What we have in view is to create a hospital culture that makes it seem natural to provide a high-quality service to visitors and patients. To this end, we will develop various activities and hold workshops.

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　　With the introduction of digital medical examination vehicles, we intended to increase the efficiency of the mass health screening services by building up an environment convenient to study radiographic images and to make them available promptly for diagnosis and treatment. However, the result was not as good as we had expected. A number of problems came up. Although high precision monitoring devices were installed for radiographic interpretations, lists of examinees expressed only in figures for identification and texts superimposed on radiographic images became so small in type size that the risks of making medical errors and mistaking one examinee for another were increased. 　　Therefore, we connected a laptop computer as a portable MWM server to the console to take in information about the examinee when he or she has an X-ray. If the examinee had no hospital ID cards, we issued a provisional ID. To differentiate the examinee with the provisional ID from the individual on the list of the examinees, the running numbers were issued, using the accession numbers indicating the date and time of examination and the kind of modality. Thanks to these new systems, it has been made possible to include information about individuals such as ID, name and sex on X-ray photos. Thus, the reliability of radiologic interpretation has been assured.

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　　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.

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　　This paper reports a case of a transcranial surgery in a patient with a symptomatic Rathke’s cleft cyst. The patient was a 54-year-old woman visited us with a chief complaint about chronic retrobulbar pain. Goldmann visual field tests revealed visual field defects in the bitemporal upper quadrant part and enlargement of the bilateral blind spot of Mariotte. MRI demonstrated a cystic lesion in the intra suprasellar region. The cyst was located on the pipuitary gland. The content of the cyst displayed hyperintensity on T1WI and hypointensity on T2WI, respectively. The diaphragma sellae was elevated and extended by the cyst. Considering a locational relationship between the cyst and the pituitary gland, and high viscosity of the cyst content, we decided to perform a transcranial surgery for an adequate resection of the cyst wall and evacuation of the content. The patient underwent a right fronto-temporal craniotomy with extradural anterior clinoidectomy. The cyst content was evacuated and the cyst wall was resected. The content was very viscid and waxy. Pathologic examination revealed that the cyst wall consisted of single or multiple ciliated columnar cells. Inflammatory cellular infiltration was also observed in the cyst wall. Retrobulbar pain subsided just after the operation and visual field disturbance also disappeared.

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　　Meige syndrome is an idiopathic disorder characterized by blepharospasm and oromandibular dystonia. Symptoms persist for a long time and treatment is difficult. This disease is categorized as a neurodegenerative disorder of extrapyramidal tract. The causes are not known well as yet. However, it has been recognized that the disease is induced by several kinds of drugs such as antipshycotic drugs and antiparkinson agents. We have treated a patient with Meige syndrome for several years. The patient is an 80-year-old-man. At age 54, he underwent total gastrectomy for stomach cancer. After the surgical therapy, he landed a job as office worker. At age 74, he suffered a left thalamic hemorrhage. He was treated conservatively. After six weeks from the onset, he was transferred to our hospital. His cognitive and daily life function were gradually deteriorating and became bedridden. When he reached somewhere around 76 years of age, he presented some of the typical symptoms of Parkinson’s disease, akinesia, tremor or muscle rigidity, so we started medication of dopamin. Three years after, he exhibited blepharospasm, retroflexion of the head and grimaced face. As this conditions continued for several months, we diagnose him as having Meige syndrome. We have decreased antiparkinsonian drugs, and started medication with trihexyphenidyl hydrochloride, clonazepam, muscle relaxant or injection botulinum toxin on eye lid and muscle of neck. Now the symptoms still linger, but his condition is not so poor.

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　　The Federation of Agricultural Cooperatives for Health and Welfare in Hokkaido (Hokkaido Koseiren) has been implementing an project in support of the infection prevention and control efforts made by general hospitals under its wings, but its member clinics had not been supported because they had no certified infection control nurses. Some years ago, Hokkaido Koseiren made an infection control check list and distributed it to each clinic, only to find that. there was plenty of catching up to do in terms of attaining the objective of infection control by the clinics alone. It became clear that many clinics lacked sufficient knowledge and technique for infectious disease control, and that they did not share the information about infections among them. Continued support to the clinics has been making some improvement in infection control. We thought it necessary to hold workshops and meetings regularly so that they can share the information about infection control.

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　　In recent years, fathers’ participation in child-rearing has been called for in Japan. There is every indication that fathers are taking upon themselves this task. However, it is said that many fathers are puzzled over this challenging fathering role and feel stressed when they are unable to engage with childcare directly. It is believed that recognition of being a father is a major factor behind this. In this study, we searched the literature in Japan and abroad regarding fatherhood recognition and examined what is important in developing a father consciousness. With “father,” “recognition,” “attitude,” “paternity,” “childcare,” and “childcare satisfaction” as keywords, we searched the literature dating as far back as 2001, using medical journals in Japan, and Scopus and CINAHL in other countries. We obtained 27 documents from the Japanese journals (including three technical treatises) and 34 documents from the English publications and classified them into the five categories:1) father figure, 2) childcare participation of father, 3) recognition of the couple’s marriage in the involvement of the husband, 4) role of father and 5) formation of father consciousness. Besides, 20 items were extracted as sub-categories. This study suggested that to foster fatherhood recognition or father consciousness, it was important to increase the intimacy between husband and wife, provide educational support, and establish a social and work environment that is friendly to paternal involvement in child-rearing.

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　　Japan’s medical expenses, which have been increasing on the back of the nation’s graying population, could be decreased, if the problem of leftover drugs is solved. This paper deals with the problem of wasted medications in an aging rural community, and examines what should be done to solve this problem. 　　A total of 226 patients, who were receiving treatment in our clinic, participated in this study. A questionnaire survey was conducted to find out if there is any stock of leftover medication, expired prescription or unused over-counter drugs, and what they were doing with old and unused medicines. Of the respondents, 38 people said they had leftover medicines. We adjusted the prescription to reduce leftovers. However, the problem of leftover drugs remained in 17% of them. They said that they would continue to hold the leftovers or simply discard them. These findings suggested that leftover drugs could cause not only waste of medical expenses but also misuse of drugs. We concluded that even if doctors were careful not to prescribe medicine more than enough, they might to be able to prevent prescription drugs from going to waste. We need to inform patients about how to do with leftover medication to avoid health risk and reduce overall medical expenses.

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