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Digital transformation, a term coined by Erik Stolterman and Anna Croon Fors, means the changes of social systems by using information and communication technologies. The healthcare industry has changed through the introduction of hospital information systems, and the Internet of Things is now dissolving hospitals in society. Recent advancements in medical artificial intelligence have increased expectations of disruptive changes in clinical practice and medical science. Therefore, all nations devote their efforts to the establishment of a key factor: a real-world data platform. A clear vision of gradually navigating citizens to a bright future and the courage to change the legislation quickly to realize the vision are keys to success.

In 2019, the Cancer Cachexia Web Questionnaire Survey(J-EPOCC)was conducted among cancer patients, their families and healthcare professionals in Japan, and it showed that the term"cancer cachexia"was highly recognized among health care professionals, whereas the staging and criteria for cancer cachexia defined by European Palliative Care Research Collaborative( EPCRC)was less understood. Also, many healthcare professionals tended to consider the term"cancer cachexia" as the terminal stage of cancer, and most of them lacked the knowledge that cancer cachexia is a disease complication which is potentially developed from the early stage of cancer. Since anamorelin was approved in 2021 for"Cancer cachexia in unresectable advanced or recurrent of non-small cell lung cancer, gastric cancer, pancreatic cancer and colorectal cancer", the treatment environment for cancer cachexia has greatly changed. Thus, the second Web Questionnaire Survey(J-EPOCC Ⅱ) was conducted in June 2022 to investigate changes in the problem awareness of cancer cachexia, especially appetite loss and weight loss, among patients and their families and healthcare professionals1). The results for healthcare professionals showed that the awareness of the staging and criteria has increased among doctors in 2022 compared with 2019, and an increasing number of doctors considered"cancer cachexia"was associated with loss of muscle mass, totally body weight loss, appetite loss and systemic inflammation that may occur in early stages of cancer. On the other hand, awareness of staging and diagnostic criteria for cancer cachexia has not remarkably changed among medical staff since 2019, with levels of awareness varying among those with different job categories. Therefore, in order to achieve early detection and intervention of cancer cachexia, it is necessary to raise the awareness of cancer cachexia among not only doctors but also medical staff by increasing their opportunities to get to know the disease condition, diagnosis, and treatment of cancer cachexia.

As the Metaverse continues to gain traction, applications the Metaverse in healthcare and wellbeing have also been growing. The rights of each user should be protected after clarifying who the service user is and the legal status of the service or action on the metaverse. Moreover, perspectives such as public equity and fairness are also critical. Appropriate agencies in Japan and abroad are required to develop guidelines and standards based on specific use cases which consider these points.

The 4th Basic Plan for Promotion of Cancer Control, which forms the basis of Japan's cancer policy, was decided at the Cabinet meeting in March 2023. Cancer, which accounts for more than 30% of all deaths in the nation, is in a sense a huge market, and the focus of large cities and corporations is achieving voluntary progress and development. On the other hand, if we rely on market principles, we will not be able to provide adequate medical care and care to rural areas, rare cancers, childhood cancers, the socially vulnerable, and the economically disadvantaged. With the declining population, and declining birthrate, aging population, it is often felt that the disparity in cancer is widening. Therefore, in the 4th Basic Plan for the Promotion of Cancer Control Programs, the overall goal was to"promote cancer control measures that leave no one behind, and aim to overcome cancer together with all citizens."On the other hand, at the end of the basic plan, I would like to ask all citizens to build good relationships of trust with medical professionals and patient families, to make efforts to receive and understand appropriate information, and to implement measures in the midst of tight financial conditions. It calls for cooperation and understanding regarding selection and concentration, and the roles and burdens of the public and private sectors.

To reduce the burden on medical professionals and achieve advanced medical care in the rapidly evolving and specializing medical field, the widespread adoption and development of healthcare AI is essential. However, there are common industry issues such as the utilization of various healthcare data, the establishment of common connection procedures based on next-generation standards, ensuring high security against threats such as ransomware, and complying with international standards such as HL7 FHIR. In order to address these challenges and promote the research and development of a Healthcare AI Platform(Healthcare AIPF)as a common industry foundation technology, the"Healthcare AI Platform Collaborative Innovation Partnership"(HAIP)was established with approval from the Minister of Health, Labour and Welfare(MHLW)and the Minister of Economy, Trade and Industry(METI). Healthcare AIPF consists of 3 platforms: the"AI Development Platform," which enables the development of healthcare AI using clinical and health diagnosis information, the"Lab Platform,"which supports AI evaluation by multiple experts, and the"Service Platform,"which provides the implementation and distribution functions of healthcare AI services. HAIP aims to provide an integrated platform that enables the entire process from AI development and evaluation to implementation.

The Special Committee for Measures Against Transition from Pediatric to Adult Health Care of the Japanese Society of Neurology, which consists of child and adult neurologists, started to tackle the issues of pediatric to adult health care transition for patients with neurological disease in July 2020. The Committee held a workshop with a theme of "cooperation between child and adult neurologists," which is a critical issue in the pediatric to adult health care transition. To solve the many problems in the pediatric to adult health care transition, it is crucial that child and adult neurologists and primary care physicians cooperate on the following issues: preparing child neurologists for the transition, encouraging adult neurologists to study child neurology, promoting the formation of multidisciplinary teams, improving the medical system and medical fees, appealing to governmental agencies for issues of community health care and welfare services.

The cooperation among medical staff, medical staff and patients, and patients and their families is important in cancer precision medicine. Cancer prevention based on genomic information should lead national cancer death as defined of cancer precision medicine in Japan.

Our hospital provides medical care and rehabilitation for individuals with disabilities. In our hospital, both neurologists and pediatricians have been working on the transition from pediatric to adult healthcare. We used a transition readiness checklist and pediatrician-neurologist transition consultation. We aimed to promote appropriate medical care, community-based healthcare coordination, and welfare services through interprofessional care with other health professionals. We assisted patients and their families in improving self-management and discussed patient issues with their best interests in mind through a shared decision-making process. Recently, the need for neurologists in transitioning patients from pediatric to adult healthcare has been increasing.

An improvement in efficacy treatment and development of the social support system has led to many patients with neurological disease being able to reach adulthood. Therefore health care for life from pediatrics to adulthood has become necessary. The Special Committee for Measures Against Transition from Pediatric to Adult Health Care of the Japanese Society of Neurology officially started to examine the current situation and issues of transition from pediatric to adult health care in July 2020. Pediatric neurologists and adult neurologists have an awareness of this issue of constructing a better transition from pediatric to adult health care. However, there are some tasks that need to be resolved in the medical system. We intend to improve the understanding of transition and assessment of medical service fees for transition in cooperation with the Japanese Society of Neurology and the Japanese Society of Child Neurology.

The current adolescent and young adult (AYA) generation represents a unique age group, among whom life changes dramatically due to living environments including school, seeking employment, marriage, and pregnancy, and due to lack of a social support system for cancer during the AYA years. The 3rd term of the Basic Plan for Cancer Control Promotion has stimulated increased momentum toward medical community involvement with AYA generation cancer patients, leading to the establishment of a Department of Cancer in the AYA Generation at our hospital. While promoting provision of highest quality team-based medical care, we have also been working to provide the best daily life/social life support, using our abundance of treatment experience, and taking into consideration various problems peculiar to AYA individuals, including anxiety about the future, a desire to preserve fertility, and a need for reproductive support. Pharmacists are involved in pharmacotherapy as part of medical treatments for AYA patients, aiming to provide optimal pharmacotherapy based on the practice of accurate pharmaceutical management. We foster collaborations between various clinical departments to tackle AYA-specific issues including preservation of fertility. Future challenges to address include long-term follow-up on such issues as late-stage disorders and endocrine disorders after AYA patient cancer treatment. Under current circumstances, our time for face-to-face interaction with patients as members of the hospital's medical staff is limited. Currently, we are involved in the operation of a breast cancer salon that aims to improve breast cancer patients' quality of life by supporting these patients during diagnosis and treatment.

Aim: To clarify the problems with accepting patients on insulin therapy at elderly care facilities., Methods: We conducted a questionnaire on staff awareness of diabetes before accepting the first diabetic patient on insulin therapy at our elderly care facility. Once the patient was admitted, we held diabetes classes for staff based on their needs. Six months later, we conducted a questionnaire again to confirm the staff's awareness concerning patients on insulin therapy., Results: In the initial questionnaire, nurses were negative about acceptance while caregivers were positive. Once the patient was admitted, staff struggled to deal with his frequent symptoms. A diabetes specialist held diabetes classes for staff to ensure the patient could enjoy a stable life. Gradually, the staff developed a better collaborative system and performed appropriate care. In the second questionnaire conducted six months later, there was a decrease in excessive optimistic opinions among caregivers. However, nurses still tended to be reluctant about acceptance while caregivers were positive, a trend similar to the initial evaluation., Conclusion: In this study, we noted differences in the perceptions of nurses and caregivers regarding the acceptance of patients on insulin therapy. Mitigating this difference is necessary to ensure the safety of patients. It is essential to institutionalize diabetes education in long-term care facilities, allow educated caregivers to measure blood glucose levels, select patients with treatment policies suitable for a given facility, ensure that doctors deliver accurate instructions, and maintain close communication to build a better medical care cooperation system.

Recently, social implementations of artificial intelligence (AI) have been rapidly advancing. Many papers have investigated the use of AI in the field of healthcare. However, there have been few studies on the adaptation of AI to clinical pharmaceutical services. We reported attempts to adapt clinical pharmaceutical services with AI in the following areas of machine learning application in prescription audits: solutions for pharmaceutical problems via speech recognition and automatic assignment of standard code to drug name information by natural language processing. Though both were exploratory attempts, we showed the usefulness of adapting AI to clinical pharmaceutical services. AI is expected to support and alter all industries in the future, including healthcare and clinical pharmaceutical services. However, AI is not magic that can solve any problem. When using an AI-adapted program, it is necessary to be aware of its features and limitations. For the coming AI era, clinical pharmacists need to improve their AI literacy.

Objective　The aim of this study was to elucidate the status of health-care, medical, and welfare planning (hereafter, "planning")-in which public health nurses (PHNs) had participated-and the factors associated with community collaboration in the implementation phase. Additionally, suggestions regarding health activities that would contribute to improving the entire community's health level were obtained.Methods　The Plan-Do-Check-Act (PDCA) cycle was the conceptual framework for this study, and the focus was the implementation phase of the plan (i.e., corresponding to the "Do" phase). Survey items were part of the "Plan" phase and identified the extent to which PHNs collaborated with community-dwellers in implementation, their demographics, their participation in the planning process, organizational factors, and the strategies used in the planning phase. The participants were full-time PHNs working in local governments who had participated in the planning process since 2013 (when the guidelines for PHNs' practices were published). A nationwide, cross-sectional survey was conducted in Japan with 2,185 PHNs from 220 regions (36 prefectures, 41 cities with public health centers, and 153 municipalities) who expressed the willingness to participate in this study. A binomial logistic regression analysis was conducted to examine the association between community collaboration and the independent variables.Results　A total of 1,281 answers (a 58.6% response rate) were received. Ultimately, 1,028 (a 47.0% valid response rate) were analyzed; exclusions were 203 for no experience in health care planning since 2013 and 50 with missing values. There were 125 (12.2%) PHNs who answered that they "did not collaborate with the community-dwellers at all," 293 (28.5%) who answered that they "did not collaborate with them much," 482 (46.9%) who replied that they "collaborated with them a little," and 128 (12.4%) who responded that they "collaborated with them a lot." The binomial logistic regression analysis showed that the following were associated with PHNs' collaboration with the community: being in a managerial position, having experience developing a health promotion plan, conducting a questionnaire survey or group work, as well as participating in municipal health planning committees with community-dwellers, utilizing research evidence, identifying target groups, and managing the plan's progress.Conclusion　From the planning phase, PHNs must collaborate with community residents and reflect their voices so that the formulated plan will help resolve medium to long-term issues in the community related to health and life.

Hokkaido University Hospital has been designated as a Core Hospital for Cancer Genomic Medicine and developed a system to provide cancer genomic medicine in Hokkaido with its liaison hospitals. Since being reimbursed in June 2019, comprehensive cancer genome profiling (CGP) testing showed certain therapeutic efficacy in patients with no standard treatment options, but it also revealed some problems such as the small number of patients who can receive therapeutic drugs matched with gene abnormalities. Since candidate drugs are often unapproved or off-label, it is necessary to smoothly introduce clinical trials, advanced medical treatment system, and patient-proposed health care service. At our hospital, we are focusing on sharing information on clinical trials being conducted in Hokkaido, launching investigator-initiated clinical trials, promoting patient-proposed health care service, promoting a registry study of genetic profiling and targeted therapies in patients with rare cancers and accompanying clinical trials, and incorporating pediatric cancer patients. This paper describes Hokkaido's cancer genomic medicine provision system, including its exit strategy, and the human resource development that serve as its foundation.

Based on the basic plan to promoting cancer control programs, a cooperation between designated cancer care hospitals and regional medical institutions was outlined. Regional designated cancer care hospitals supports the system of regional cancer medical treatment cooperation, and prefectural designated cancer care hospital manage a prefectural cancer medical treatment cooperation. Although system is progressing, such as sharing regional cooperation pass and holding multi-facility joint meetings to promote regional cooperation, there are regional disparities, and we believe that further promotion is necessary.

Nowadays, approximately 90 percent of the general population in Japan uses the internet and many of them look for health-related information. However, there have been serious concerns about the contents and credibility of these information. Among "mixture of wheat and chaff", information provided by the public domains are expected as accurate and reliable ones. This article reviews five public websites that provide health or health care information for users including the general population: Minds by the Japan Council for Quality Health Care, e-health net, evidence-based Japanese Integrative Medicine (eJIM), Cancer Information Service by the National Cancer Center, Center for Cancer Control and Information Services, Information system on safety and effectiveness for health foods (HF net) by National Institute of Health and Nutrition. These websites show their running policy transparently and have constructed collaborative relationships with each domain experts, and from the people who are not related with the healthcare field including patients in some cases. Each of them is content-rich and well-organized as an individual unit. The organizations that run these websites share the common goal that provides the general population with quality health-related information, however, cooperation have been limited. To increase awareness among the public, it is worthy considering joint efforts of these organizations in future.

Medical big data, also referred to as 'real-world data' (RWD) is defined as "data related to patient health status and/or health care delivery collected routinely from a variety of sources". This includes data from disease and drug registries, electronic health records, claims and billing data and census data collected from clinicians, hospitals, and payers. Observational studies using RWD collected during general clinical practice are considered complementary to randomized control trials. However, since this design does not allow the random assignment of patients, causal inference analyses are required. Researchers should study the protocol properly before considering the combination of study design, the characteristics of data source, calculation of the appropriate sample size and the validity of outcomes. Data definition using data code should also be considered. Furthermore, the reliability of the source studies must be considered and discussed when the article is written. This review aims to outline the methods for performing reliable observational studies using RWD.

Based on the results of comprehensive cancer genomic profiling(CGP), only about 10% of cancer patients can be candidates for anticancer drugs that match genetic abnormalities. In the current situation in Japan, clinical trial(BELIEVE trial)is on-going to provide patients with medical treatment opportunities based on the results of CGP test. In this study, patients can try an off-label drug under the Patient-Proposed Healthcare Services who are not eligible for clinical trials such as trials for drug approval, or Advanced Medical Treatment B. More than 40 patients have already participated in the BELIEVE trial. In this section, I will discuss the current status of the BELIEVE trial, challenges in multidisciplinary collaboration, and future prospects.

Objectives: This study aimed to consider the appropriate occupational health system for Japanese enterprises in the Philippines based on information on the regulations and development of specialists., Methods: We collected information using an information-gathering checklist. Along with literature and internet surveys, we conducted interviews by visiting local business sites, central government agencies in charge of medical and health issues, and educational institutions with specialized occupational physician training curricula., Results: Occupational health administration in the Philippines is managed by the Department of Labor and Employment, which issues the Occupational Safety and Health Standards that specify the legal requirements for occupational health. A new law(Republic Act 11058),enacted in 2018 to strengthen the Occupational Safety and Health Standards, has newly established a penalty provision in case of violations. Professional personnel responsible for occupational health are grouped as safety officers and occupational health personnel, including occupational physicians and occupational nurses; training is conducted at the Occupational Safety and Health Center of the Department of Labor and Employment and educational institutions. The basic medical insurance system and the workers' compensation system are operated by the Philippine Health Insurance Corporation and Social Security Committee, respectively, both of which are government agencies., Conclusions: We confirmed that occupational health activities in the Philippines are based on government regulations, namely, the Occupational Safety and Health Standards. In addition, the enactment of a new law calls for strict compliance with corporate occupational health activities. To manage proper occupational health activities at overseas workplaces, Japanese corporations should clarify corporate-wide policies and support local employers in complying with regulations and utilizing highly specialized personnel.

Japan's health care system can be regarded as one of the best worldwide, provided it remains sustainable. It has relatively low costs, short wait times, low disease incidence, and high life expectancy. However, universal coverage in Japan faces financial challenges due to the country's rapidly aging population. Canada is another of the few developed countries that have universal health coverage. In contrast to Japan, Canada's health care spending is still sustainable according to recent studies. Effective cost control by payers has played a major role, with providers being steered toward evidence-based and cost-effective drug therapies. Furthermore, expanded pharmacy services have been important in suppressing spending on prescription drugs and minor health care services such as vaccination, government-funded smoking cessation, and medication review programs. This article outlines the services provided by Canadian pharmacists with expanded scope of practice. The pharmaceutical profession and its advocacy body in Canada have not only played a role in regulatory changes, but also put in place technological infrastructure called PharmaNet and contributed to appropriate prescribing. Given the current economic situation and demographic trends in Japan, more options should be explored in order to maintain universal health coverage by meeting the funding gap. Utilizing community pharmacies and pharmacists is proposed as one option.

In October 2015, the Ministry of Health, Labour and Welfare of Japan newly included "health support functions" and "advanced pharmaceutical control functions" as part of "primary-care pharmacy" in the pharmacy vision for patients. "Health support functions" were defined as recommending that patients seek medical consultations, introducing them to relevant medical institutions, and contributing to disease prevention and health support among local residents, apart from health counseling and the consolidation of a framework for the appropriate selection and supply of and advice on pharmacist-only over-the-counter medications, etc. On the other hand, the term "advanced pharmaceutical control functions" is presumed to imply meeting the needs for advanced pharmaceutical control, e.g., cooperation with specialized medical institutions in addressing adverse reactions caused by anticancer drugs and support of the selection of anti-HIV drugs. However, the details remain unknown. Since the opening of the Akebono pharmacy group 22 years ago, our staff members have visited home-care patients, controlled and guided the use of pharmaceuticals, and supported all types of home-care patients including those with end-stage cancer and amyotrophic lateral sclerosis, undergoing home parenteral nutrition, and pediatric home-care patients. We have experienced many cases requiring sophisticated pharmaceutical control, e.g., pain control with opioids, sterile preparation of transfusions, and supply of special medical devices. We would like to consider the requirements for pharmacy-provided home healthcare that depends heavily on medical treatment as one advanced pharmaceutical control function.

Due to promotion of home medical care, the number of patients who highly depend on medical care is increasing. Therefore, the role of pre-discharge conferences where a care manager is involved starting from pre-discharge support has become more important. In addition, in a usual relationship, cooperation between the hospital staff and the home care support team is crucial. Among home care workers, the word "coordination" has generally been used for a long time to prepare for the transfer of patients from a hospital to home. However, there is a considerable gap between healthcare and caregiving; consequently, it is difficult to actually create coordination between them because the terms to be used and the contents mastered by personnel in each field are different. In this paper, we report a case of successful coordination for smooth transfer of a patient with ALS from a hospital to home, by creating a homecare team in which all members work together based on the information obtained from a hospital social worker.

Home care and at-home-based palliative care for cancer patients are being improved bythrough a basic law on cancer control and subsequent institutional reforms in 2007. However, in the revision of the medical treatment fee in 2018, it is a big feature that the facilitystandard for the waiting days and the home return rate was built in the palliative care ward. The number of inpatients in our palliative care department was 3,835 in the 5 years from 2013 to 2018. It consists of 2,414 in general wards and 1,421 in the palliative care ward, regarding the home return rate, the total was 27.5%, but there were 891 from the general ward and 163 from the palliative care ward. In the future, the role of palliative care wards is expected to change, shorting the number of waiting days, and providing a much greater degree of flexibilityin the wayof promoting home care. The important thing is to establish a system to be able to choose the place of recuperation quickly depending on the patient, familysituation, and their hope. Hence, we aim to strengthen the home-visit system by emphasizing the continuityof medical treatment while maintaining the relationship of mutual trust among the local cooperative clinics.

Medical advances have made it possible to save lives of children with severe refractory diseases. As a result, the number of children who need continuous medical care at home has increased. However, there are concerns that many pharmacies are not actively involved in, because the dispensing fee does not match their prescriptions, which are very complicated and contain some high-risk medicines. We analyzed the burden of dispensing prescribed medicines so that we can quantitatively discuss from prescription contents. The essence of the burden of a pharmacy regarding home medical care for children is to cover the transportation of heavy pharmaceuticals and the combination of multiple medication including high-risk medicines and lack of pediatric drug formulations with the efforts of the on-site pharmacist. It became clear that the pharmacist's objective work supports pediatric pharmacotherapy.

We divided acute ischemic stroke patients into an oldest old group (≥90 years, n = 414) and an elderly group (75-89 years, n = 1,927), and compared the clinical characteristics between the two groups. Female sex, early admission, severe stroke on admission, atrial fibrillation, and cardioembolic stoke were significantly more frequent in the oldest-old group. On the other hand, risk factors associated with atherosclerosis were less frequent in the oldest-old group. There were no differences in hyper-acute recanalization therapy between the two groups, whereas antithrombotic therapy for secondary prevention at discharge was introduced less frequently in the oldest-old group than in the elderly group. Death prior to discharge from the acute care hospital , and death at 3 months were significantly more frequent in the oldest-old group. Moreover, in the oldest old group, severe stroke and atrial fibrillation were independent predictors for both death prior to discharge from the acute care hospital and at 3 months after onset. Oldest-old stroke patients had poor outcome, although they had received aggressive treatment as same as elderly patients. Therefore, as the number of oldest-old stroke patients is increasing, the demand for cooperation in the healthcare system is likely to grow, including acute care hospitals.

Purpose: This study aimed to clarify the utility of the Life-trouble Scale-based care planning tool for elderly patients with dementia (Life-trouble Scale, viewpoints, and care points of the elderly with dementia suffering from life troubles) in order to develop an appropriate care plan and practices in a long-term care health facility., Method: Participants were elderly patients with dementia who were evaluated by care staff using the abovementioned scale at baseline and after intervention (one month later) from September to December 2017. The patients were divided into an intervention group, which received care based on the Life-Trouble Inclusion Scale, and the control group, which received the usual care. The outcomes of these two groups were compared., Results: The intervention and control groups comprised 14 and 12 elderly patients with dementia, respectively. More than 60% of the care staff worked with both groups. Scores on the agitation sub-scale of the NPI [please define abbreviation] and "life-trouble associated with irritation and confusion" sub-scale of the Life-Trouble Scale improved significantly in the intervention group. Among the care staff, self-efficacy related to caring for elderly patients with dementia and scores on the Emotional Exhaustion and Depersonalization sub-scales of the Japanese version of the Maslach Burnout Inventory improved significantly., Conclusion: The present findings suggest that care intervention using the Life-trouble Scale-based care planning tool was beneficial for both elderly patients with dementia and their care staff.

In 2016, the Cancer Control Act was revised, with emphasis on support for people living with cancer, the public's understanding of cancer patients, continuation of employment of cancer patients and cancer education, etc, was added. In order to make policies effective, it is necessary for society to listen to the voices of cancer survivor and to know the current situation of issues they face on. We, CancerNet Japan have been supporting cancer patients through the 2 projects "Breast cancer Experienced Coordinator(BEC)Training Course", started in 2007 and "Over Cancer Together(OCT)Campaign", started in 2013. We have educated the knowledge and skills that are required for cancer survivor to utilize their experiences. There are more than 400 graduates who have completed each 2 courses. Some engaged in consultation support activities as a peer supporter in hospitals and areas, other serve as local cancer promotion committee members, and give lecture activities. These 2 projects that have supported cancer survivorship were to support the process of enhancing advocacy, cancer survivor gaining correct knowledge, standing with their own power, disseminating their own experiences and issues based on it, and taking actions to resolve.

Based on the Cancer Control Act approved in June 2006 and the National Cancer Control Plan, cancer control promotion council including cancer patients in Ministry of Health, Labor and Welfare(MHLW)has discussed about cancer survivorship from the viewpoint of the reduction of economic burden on cancer patients and supporting cancer patients to be independent and MHLW has taken measures especially in the employment support for cancer patients. On the other hand, cancer survivorship is a theme related to general living of cancer patients after cancer diagnosis. In order to promote measures on cancer survivorship in Japan, not only the employment support for cancer patients but also the research and support for multifaceted areas are needed.

The landscape architect Maggie Jencks felt that she wanted a place to "get herself back" when her breast cancer recurred and was told that she only had a few months remaining. Mr. Charles Jencks, her husband who fulfilled her wishes, opened the first "Maggie's Cancer Caring Centre" in Edinburgh in 1996. Masako Akiyama, the chief of Maggie's Tokyo found out about Maggie's Centre when she listened to a presentation from Andrew Anderson, the director of Maggie's Edinburgh, at an International Nursing Seminar in 2008. Masako Akiyama realized that support to "get back ones own power" is one of the important things. In addition, she felt that providing a "place" and "support" to patients and their families were predominant elements. When someone is diagnosed with cancer, the person gets a great shock and feels loneliness. Suddenly the person feels tomorrow will not come, every day becomes uncertain. These feelings affect their whole life such as enrollment, employment, loss of role, and change. They also affect people such as family, friends, colleagues, besides the person. Due to changes in treatment, the existential troubles that have been prolonged after the completion of the initial treatment appear. Cancer survivorship is called "Cancer journey"in the Maggie's flow. The cancer journey suddenly starts, when a person is diagnosed with cancer", without direction or a plan. Additionally, the "heart"is often left behind. To undertake the cancer journey, there are a lot of forks in the road that cannot turn back and they are urged to choose their path. "Where now ?"is a phrase in a pamphlet from Maggie's Centre, and the phrase shows that staff of Maggie's Centre can help cancer patient to recognize where they are in their Cancer journey. The Maggie's Centre has 2 important pillars: "building/environment"and "human support". As a "homely place" between hospital and my house, the building is "a healing space". Human support is provided free of charge and patients and families can stop by without reservation. Experienced cancer specialists and medical staff are always available. Unlike previous supportive methods for patients such as giving information and helping to solve problems, Maggie's emphasizes the 3 points of "snuggling up to each individual", "equal footing" and "to cherish their likeness empowerment". By talking to Maggie's medical professionals, patients and families can find their "heart" and regain their original strength.

In order to double the number of pancreatic cancer survivors, we need to develop early detection tool and new therapies that control stage IV metastatic disease. Pancreatic cancer survivors are slowly increasing and we would appreciate welcoming them to the cancer survivor community.

Objective: Expatriate workers and their families may encounter difficulties and uncertainties when visiting local hospitals. These problems include differences in the medical system, higher healthcare costs, and language problems. Occupational health staff in companies need to know about the healthcare system, including emergency transportation arrangements, to reduce anxiety in workers and families attending hospitals. This study was designed to create a checklist to allow occupational health staff to collect information from overseas hospitals efficiently and effectively., Methods: We used documentary searches and the knowledge and experience of researchers to identify the support requirements of expatriate workers and drafted a checklist for information collection from overseas hospitals. The validity of the checklist was assessed in two stages. First, we interviewed health specialists caring for expatriate workers and their families and then tested the draft in international hospitals. We revised the draft based on our findings and again tested the new version in different overseas hospitals, enabling us to create a final version of the checklist., Results: Our checklist contains 12 major categories: reception, administration, inpatient wards, available tests, outpatient clinics, emergency services, pediatrics, gynecology, dentistry, general health check-ups, vaccination services, and precautions against infection. These categories cover a total of 51 subcategories, each of which is further divided into a total of 131 smaller categories., Discussions: Occupational health staff can use this checklist to gather information in order to provide comprehensive and effective support for expatriate workers attending hospitals. We recommend that the staff gather all possible information from hospital websites before visiting and use the visiting time to gather information available only on site. In order to gather as much information as accurately as possible, the staff are recommended to visit the facilities related to the checklist categories, that is, Japanese language reception, outpatient services, inpatient wards, emergency services, pediatrics, gynecology, general health check-up centers, and cardiac catheterization labs, and obtain information directly from doctors, nurses, and specialists working at the hospitals.

It may not be common for laboratory tests to be employed immediately after a disaster in front-line healthcare settings. However, this is not because laboratory tests are not needed in post-disaster healthcare settings, but because the implementation of triage, which prioritizes the saving of lives, is the initial aim of a Disaster Medical Assistance Team (DMAT). Disaster response ability has been reported to be exerted according to the level of experience. After the Great East Japan earthquake, by the cooperation of related societies and organizations, diagnostic reagents and instruments were supplied to 3 core university hospitals in the affected areas, contributing to building a system whereby necessary medical items could be obtained in three affected Prefectures of the Tohoku region. We should always remember that front-line medical care activities in affected areas are possible due to the backup provided by logistic support teams. The more the system for DMAT is improved, the more effective the support system will be after the super-acute phase of a disaster. [Review].

We have developed a cloud system, the e-Renraku Notebook (e-RN) for sharing of home care information based on the concept of "patient-centricity". In order to assess the likelihood that our system will enhance the communication and sharing of information between home healthcare staff members and home-care patients, we selected patients who were residing in mountainous regions for inclusion in our study. We herein report the findings.Eighteen staff members from 7 medical facilities and 9 patients participated in the present study.The e-RN was developed for two reasons: to allow patients to independently report their health status and to have staff members view and respond to the information received. The patients and staff members were given iPads with the pre-installed applications and the information being exchanged was reviewed over a 54-day period.Information was mainly input by the patients (61.6%), followed by the nurses who performed home visits (19.9%). The amount of information input by patients requiring high-level nursing care and their corresponding staff member was significantly greater than that input by patients who required low-level of nursing care.This patient-centric system in which patients can independently report and share information with a member of the healthcare staff provides a sense of security. It also allows staff members to understand the patient's health status before making a home visit, thereby giving them a sense of security and confidence. It was also noteworthy that elderly patients requiring high-level nursing care and their staff counterpart input information in the system significantly more frequently than patients who required low-level care.

Minds (Medical Information Network Distribution Service) is an information service provided by the Japan Council for Quality Health Care (JCQHC), a public interest incorporated foundation. The Minds guide for developing clinical practice guidelines was published in 2014. The aim of the Minds project is to help medical practitioners fully utilize information related to evidence-based medicine (EBM) in their practice. Minds also provides patients and the public with information to help understand the basics of diseases and share up-to-date evi- dence with doctors, on which modern medical practices are based. Overall, clinical practice guidelines are made up as follows : 1) a three-layered structure of guideline committees con- sisting of a managing committee, guideline creation team, and a systematic review team, 2) a clear description of the basis for an individual's judgment and COI, 3) evaluation of the body of evidence summarized for every outcome and study design in all selected research reports for each Clinical Question (CQ), and 4) not only the "benefit" but also the "harm" in the patient outcome caused by intervention are to be included in the evaluation. According to the Minds method, the Japanese Society of Neuropsychopharmacology has created a "Guidelines for Pharmacological Therapy of Schizophrenia." These guidelines were introduced to explain the characteristics of the Minds method in this paper. The Effectiveness of GUIdelines for Dissemination and Education in psychiatric treatment project (EGUIDE proj- ect) was also introduced to disseminate and evaluate these guidelines.

The certified public psychologist (tentative name) was introduced as a versatile profession, which covers the fields of medical, healthcare, welfare services, industry, and law. In this study, I report the process of how certified public psychologists were introduced, indicate their char- acteristics in the medical field, and make proposals on their expected roles and associated tasks. Since their professional involvement in psychiatric care, healthcare, and welfare settings has shifted from hospital- to community-based care, the care system has also changed from a team-based care approach to a multi-professional collaborative system. Experts involved in the multi-professional collaborative system are required to exert their skills based on professional knowledge and experience, and also to be equipped with human strengths as a generalist based on experience accompanied with wide-ranging education. Responding to such a trend, in addition to the payments made for each of their services, such as psychological assessment, treatment, and education, I would like to request financial reimbursement by the medical fee system for professionals working in team-based medical and multi-professional collaborative settings. I strongly hope that certified public psychologists, who have been involved in the medical field for more than half a century, will become financially secure upon being certified through a national qualification, and play an active and worthwhile role as full-time employees in each setting while responding to the needs and expectation of patients, clients, and other medical workers.

Recent advances in cancer treatment have steadily improved the overall survival rate, and enhancing the quality of life of cancer survivors is the challenge faced at present. One of the major topics in studies on cancer survivors is work-related issues, and the government has been focusing on improving the circumstances of the working population and children. In 2015, the Cancer Control Accelerating Plan set adolescent and young adult(AYA)cancer survivors as the top priority for this plan. Work-related issues of AYA cancer survivors are highly individualized and complicated, mainly because of three characteristics: 1 ) Cancer treatments and/or outpatient follow-ups are accompanied by major life-stage transitions, 2 ) Treatments are prone to be nonstandardized in "rare cancers" or "advanced-stage cancers" and 3 ) Achieving economic independence is difficult because of high medical costs. This article provides some tips for medical professionals working in hospitals on how to support AYA cancer survivors along with their main responsibilities. It also provides an overview of online and offline resources available for supporting this population.

In Japan, the number of people who suffer with cancer once in their lives has increased since 1985, and the 5-year relative survival rate for cancer patients continues to improve. As a result, there have been reports on the difficulties faced by working age patients because they attempt to simultaneously undergo cancer treatment and work. In June 2012, the Ministry of Health, Labour and Welfare published the Basic Plan to Promote Cancer Control Programs with improved cancer countermeasures for working people and children to manage problems related to the employment of cancer patients, and it has been subsequently promoting these initiatives. A report on the needs and problems faced by medical facilities regarding the employment of cancer patients, survivors, and their family members was presented at an investigative commission in August 2014 that assessed ways to support the employment of cancer patients and survivors. In February 2016, the Ministry of Health, Labour and Welfare released its guidelines on providing workplace support to people attempting to simultaneously undergo treatment and continue working. The authors conducted an interview survey of clinical nurses who provided employment and life support to cancer patients. In this study, we present examples of employment support practices provided to cancer patients by clinical nurses that we hope will be helpful to medical facilities providing such support.

Advances in testing and information technologies have expanded the availability of Point-of-Care Testing (POCT) devices not only in healthcare but also in non-healthcare settings. POCT laboratory accreditation under ISO 22870 has been implemented in conjunction with ISO 15189 in European countries. A markedly increasing number of facilities are performing POCT in non-healthcare settings in the United States with a certificate of waiver and in European countries; concerns are being raised on the lack of oversight and re- quirements for personnel qualifications and training. Centers for Disease Control and Prevention have been making efforts to develop educational tools. In ISO Technical Committee 212 (ISO/TC212) on clinical labor- atory testing and in vitro diagnostic test systems, guidance for POCT operators is proposed, being designed as a document for operators in healthcare and non-healthcare settings who lack specific medical laboratory training. In Japan, on the basis of the international efforts on standardization and quality assurance, nation- wide efforts are necessary for increased reliability and confidence on performing POCT to promote the cost- effectiveness and quality of healthcare services.

Point-of-Care Testing (POCT) has been increasingly implemented in healthcare, on the basis of advances in analysis and information technologies. Wherever POCT is implemented, it needs to be properly and safe- ly performed. However, a concern has been raised that it is preformed without training and support from the clinical laboratory and, thus, testing reliability and patient safety are not sufficiently ensured. Laboratory professionals and experts are expected to play an important role in the solution of this issue, through provid- ing guidance and support in the proper implementation and patient safety of POCT. Hence, this symposium was organized to summarize current situations and issues of POCT expanding into health care, the communi- ty, and home, and to clarify the way to challenge them as laboratory professionals for increased reliability and confidence on performing POCT, contributing to the cost-effectiveness and quality of health-care services.

Japan is one of the leading countries worldwide in terms of longevity. However, with the increase in the elderly population, the number of individuals requiring some type of daily living assistance has currently exceeded 6 million. Cerebrovascular disease is the main reason for the requirement of care among the elderly. However, individuals in the late old age (≥75 years)-the number of which is rapidly increasing-also experience problems related to the functional decline of their musculoskeletal system, owing to age-related frailty and falls/fractures. Increasing the amount of physical activity not only helps prevent the onset of lifestyle-related diseases, but can also prevent the age-related decline in motor function. Hence, elderly individuals should perform exercises for health promotion and preventative care. However, as the physical functions and chronic diseases differ among individuals, it appears that the exercise programs offered as part of primary and secondary prevention programs may not be effective. Hence, physical therapists should play a large role in establishing appropriate and individualized exercise programs, as they have considerable experience in providing exercise therapy in the context of medical care for elderly people with varying conditions and risks.

The Psychiatric Care and Mental Health and Welfare System Committee surveyed the contents of mental disorder medical care plans established by the 47 prefectures in Japan. Based on the "opinions of the Japanese Society of Psychiatry and Neurology Board of Directors following the official recognition of mental disorders as important diseases under the Medical Service Law's medical care plan" (September 28, 2011), investigations were conducted focusing on three aspects : locations of medical care plan discussions, public awareness of medical care information, and target values. Medical care plans of the 47 prefectures were collected. A ques- tionnaire regarding the mental disorder care plan decision process was sent to each prefecture, and answers were received from -those in charge of each jurisdiction. Among the 45 prefec- tures that responded, the mental disorder care planning groups held an average of 3 meetings. The largest number of meetings held was 7 (in 3 prefectures), and 2 meetings or fewer were held in 15 prefectures. No meeting was held in 7 prefectures. Locations in which the promotion of regional medical care cooperation regarding mental disorders was discussed were recorded by less than half of the medical care plans. The names of the medical facilities that were recorded in many of the medical care plans included various functions, such as "facilities for emergency psychiatric care" and "dementia medical centers." However, medical care functions specific to various mental disorders and medical facility names including these functions were only recorded in approximately half of the medical care plans. Regarding target values for promoting medical care plans, the vast majority of prefectures recorded that the "average in- patient discharge rates occurred in under 1 year."A relatively large number of prefectures also recorded "suicide mortality rates". and the "number of dementia medical centers" ; however, there were hardly any records concerning "rates of in-patient hospitalization for medical care and protection lasting more than 1 year." Moreover, there were few records regarding the "number of patients (per 100,000 of population) hospitalized for medical care and protection each year" and the "percentage of patients receiving care in protective room isolation." While prefectural medical care plan contents are varied, definite improvements of psychiatric care through medical care planning are finally underway. Mental disorder medical care plans based on the Medical Service Law operate together with related documents such as the guideline based on the Mental Health and Welfare Act, Article 41 ; disability welfare plans based on the Comprehensive Support for Persons with Disabilities Act ; and long-term care plans based on the Long-term Care Insurance Act. Further implementation and assessment, and continued revision based on this assessment, are needed with regard to these related plans and guidelines.

What should we educate for Kampo medicine in the model core curriculum of pharmaceutical education? The curricular core should be discussed considering the points mentioned below. (1) Positioning of Kampo medicine in the Japanese medical care system. Kampo medicine is an authorized medical care category in the National Health Insurance (NHI) program in Japan. The NHI drug price list carries 148 Kampo formulations. According to the report of the Japan Kampo Medicines Manufacturers Association in 2011, approximately 90% of Japanese physicians prescribe Kampo medicines. (2) Differences between Kampo medicine and western medicine: In Kampo medicine, the most suitable formula among various Kampo formulas to normalize the psychophysical state of individual patients is selected. In other words, if there is a complaint, there are always some treatments. (3) A strong point of Kampo medicine: Kampo medicine enables physicians to deal with difficult-to-treat conditions by western medicine alone. Also, by using the scale of Kampo medicine, each patient can grasp his or her own systemic state and improve their lifestyle. To extend healthy life expectancy, a basic knowledge of Kampo medicine may play a significant role in integrated health care. "The guide book of the approval standards for OTC Kampo products", "the pharmaceutical advanced educational guideline", and "the manual of the exam questions preparation for registered sales clerks" should also be consulted before selecting the area and contents that should be covered.