[in Japanese]

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[in Japanese]

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This paper attempts to review recent trends in policies for the elderly and the aging, clarify how policies change, and discuss important research themes in this field. This study first reviews trends in the following three aspects . The first is the ideal types of caregiving in the long-term care insurance system. The second is the policy that determines the quantity of care resources. The third is the policy that regulates the caregiving relationship. From this overview, we identify two issues in this field. The first is that the current model of caregiving tends to be distant from the original idea to help the elderly independent . We need to evaluate this tendency. The second is that there is a restructuring of systems under the tendency of reining the total amount of medical and elderly care benefits. We need to investigate how to develop the restructuring in each field.

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This paper shows briefly the bio-political process of the rise of the Japanese organ transplantation system. Under the organ transplantation law enforced in 1997 and its revised version enforced in 2010, not only some patients who have willingly decided to be a donor, but also those who do not have done yet any decision making to be a donor or not at the critical moment can be legally good donors in order to increase in number of harvesting live organs from 'brain-dead' patients only by proxy of his/her family. Now we should carefully discuss the following issues in the world of medical sociology in Japan: 1) how the law might violate the patient's right of self-determination as the Japan Federation of Bar Associations pointed out; 2) how the organ transplantation system might intervene in progress of surgical neurology with the law emphasizing that doctors need not use 'therapeutic hypothermia' that sounds the symbolic treatment of patients with threatened 'brain-dead' or cardiac arrest state; 3) how the concept of 'brain death', therefore, might be well re-conceptualized; 4) how the alternative treatments (like 'artificial organ', 'regenerative medicine', 'Batista operation' etc.)to organ transplant might be re-estimated; and 5) how the organ transplantation might realize an eternal utopia or a close game like lottery for the recipients.

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Governmental regulations and external review mechanisms for biomedical research were introduced in Japan in the late 1980s. However, there are two major problems yet to be overcome: 1) lack of a clear definition of research and 2) inconsistency among regulations for the protection of participating human subjects. In this paper, I discuss these two problems referring to the recent development of administrative guidelines over biomedical research in Japan. Regarding the former, the 2007 version of the Guidelines for Epidemiological Research introduced a standard for the distinction between research and medical practice. However it does not tell us how the gray zone between research and practice should be regulated. Regarding the latter, the 2008 version of the Guidelines for Clinical Research introduced a stricter regulation for those clinical trials which use already approved drugs or medical devices. Although these new guidelines lead to more consistent regulations, there is still a significant difference among guidelines regarding their binding powers.

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In a medical setting, although multitasking and interruptions in tasks of nurses lead to errors, little is known about the situation in Japan. We conducted a time-and-motion study and video analysis to determine the number and types of tasks and interruptions in these tasks of four nurses and two pharmacists in a hospital in Japan. With regard to multitasking, the nurses performed 39.3 tasks per hour; this number was 19.8 in the case of the pharmacists. The nurses and pharmacists were interrupted in the middle of their tasks 9.3 and 8.0 times per hour on average, respectively. At the nurses' station, the telephone and the nurse call system rang 47 and 81 times in a day, respectively. Our results suggest that nurses experienced more interruptions and managed more tasks concurrently. To prevent errors, nurses' tasks should be divided among other workers such as pharmacists.

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