The places of death for older people are homes, social welfare facilities and medical institutions, with the latter accounting for almost 80% of deaths. Community-based-service（CBS）facilities are catering for rapidly increasing numbers of older people with dementia and there is a requirement for them to allow users to die a peaceful death without having the disruption of moving. However, there are a number of complexities in the provision of end-of-life care in CBS facilities outside medical institutions. This study presents an overview of the current status of end-of-life care in CBS, and explores the effectiveness of education programs for staff members, users’families, and community residents.

End-of-life care was not provided in the majority of CBS facilities in a city in western Japan mainly because of a lack of 24-hour medical cover and inadequate professional development for staff. We focused on upskilling staff and held two training sessions on end-of-life care；one for the city’s CBS staff and the other for all staff, families, and community residents.

Evaluation of the interventions suggests that obtaining knowledge on end-of-life care and sharing information with each other allays staff workers’anxieties and fear about end-of-life care and enable them to provide care of the dying in situ. The study indicates that educational programs could be a useful way to promote quality end-of-life care in CBS.

Cervical myelopathy of ossification of the posterior longitudinal ligament（OPLL）is induced by static factors, dynamic factors or a combination of both. We used a 3-dimensional finite element method to analyze the stress distributions of spinal cord of compression by OPLL. Experimental condition for spinal cord, lamina and OPLL with ossification. To simulate static compression, 10%, 20% and 30% anterior static compression of the AP diameter of the spinal cord was applied to the spinal cord by OPLL. To simulate dynamic compression, OPLL is rotationed 5°, 10°and 15°to the flexion direction. To simulate static and dynamic compression, under 10% and 20% anterior static compression, OPLL is rotationed 5°, 10°and 15°to the flexion direction. The stress distribution in the spinal cord increased following static compression and dynamic compression. In both of static compression and dynamic compression, more than static compression increases, more than stress distribution increases even mild range of motion. There is possibility that the symptoms appear just static compression and dynamic compression only. However, under static compression, the stress distribution increases with ROM of the responsibility level and this makes it very likely that symptoms will worsen.

【Purpose】A time and motion study to ascertain how a public health nurse spent her time.

【Methods】A public health nurse was continuously observed from the beginning to the end of her shift and activity recorded on a minute-by-minute basis. She also completed a commonly-used Ministry of Health, Labour and Welfare survey about how she spent her working hours and free descriptive answer about the survey’s user-friendliness and utility.

【Results】The nurse’s observed total working time was 526 minutes with 75 nursing activities, classified into 10 categories. These included communication with residents（24.7%；130min）；liaison with other institutions（15.4%；81min）；evaluation and review of individual cases（9.5%；50min）；and consultations with colleagues and managers on community activity（13.5%；71min）．In contrast the nurse self-reported that her working hours comprised 4hours health and welfare services, 2hours coordination, and 2hours documentation.

【Discussion】“Consultations with colleagues and managers”and“evaluation and review of individual cases”lead to skill development. The nurse spent two hours on these tasks indicating that PHNs cultivate practical skills in their daily work. Ensuring that time was reserved for consultation and information sharing is important for skill development. Further research on their activity details is required to verify this research.

We retrospectively reviewed three cases of thoracic empyema treated by video-assisted thoracic surgery（VATS）with some literature. In case 1 and 2, thoracoscopic debridement and drainage were successfully performed, removing fibrin clots and septa from pleural surfaces. In case 3, the duration of symptoms before operation was over 5 weeks. Because of severe adhesion between lung and chest wall, he received a same thoracic surgery in which mini-thoracic incision was added. For the multiloculated or deeply-located acute thoracic empyema ineffective by percutaneous chest drainage. VATS is a less invasive, safe, and effective therapy. Timing of early surgical approach using thoracoscopy is important or critical.

A 67-year-old man, with prior open reduction and internal fixation surgery for a proximal humeral fracture 3 months before, was admitted for wire extraction and shoulder mobilization to relieve joint stiffness.

General anesthesia and continuous interscalene brachial plexus block（CISB）were scheduled. A Contiplex® C needle（B.Braun）was inserted between C5 and C6 under ultrasound guidance before induction of general anesthesia. After 15 mL 0.25% levobupivacaine was injected, the needle was withdrawn while holding the catheter. No significant change in vital signs was observed intraoperatively. Continuous infusion of 0.2% ropivacaine at 6mL/h was started immediately postoperatively.

The patient presented motor block only on the day of the surgery. The reported Visual Analogue Scale scores for pain at rest and on rehabilitation were 0?20 and 26?65 mm, respectively. During the infusion of CISB, supplemental analgesia was only 1 tablet of loxoprofen. The catheter was removed on postoperative day（POD）3 and the patient discharged on POD13 with good range of motion in the shoulder joint. Pain after shoulder surgery hinders effective physiotherapy；however, this patient was able to undergo rehabilitation with decreasing pain because of CISB use.

A 56 -year-old man received the incision and drainage of the perineal skin abscess in 15 years ago. He was constantly aware of the small mass. About half a year ago, he noticed the increase of the mass. He visited a nearby hospital for the pain and bad odor one month ago. The biopsy specimen of the mass showed the existence of squamous cell carcinoma, and he was referred to our hospital. The hen's egg-sized subcutaneous tumor in the perineal area was elastic hard. The central part of the tumor had self-destruction. CT showed well-defined mass in long diameter 43mm with clear contrast effect in the peripheral zone. Lymphnode metastasis or distant metastasis were not recognized. We performed tumor resection under general anesthesia. Histopathological findings showed completely resection of well-differentiated squamous cell carcinoma. Clinical stage was Stage II（T2 N0 M0）．Recurrence dose not recognize in postoperative 3 years. We reported a rare case of squamous cell carcinoma that occurred from atheroma of the perineum.

A 36-year-old man who complained upper abdominal pain was referred to our hospital. Esophagogastroduodenoscopy indicated a Y-II type polyp, 5 mm in diameter, on the greater curvature of the upper gastric body. There was no atrophy of the gastric mucosa, and anti-Helicobacter pylori antibody was negative. Biopsy revealed a low-grade differentiated adenocarcinoma with gastric phenotype expression. MUC5AC was predominantly expressed in the tumor, so we diagnosed adenocarcinoma of the gastric foveolar type. The tumor was completely resected by biopsy. There was no tumor in a specimen retrieved by endoscopic mucosal resection. This was a rare case of low-grade differentiated adenocarcinoma of the gastric foveolar type arising in a Helicobacter pylori -negative stomach.