Development of a Psychological Scale for Measuring Disruptive Clinician Behavior.

Objectives: Disruptive clinician behavior worsens communication, information transfer, and teamwork, all of which negatively affect patient safety. Improving safety in medical care requires an accurate assessment of the damage caused by disruptive clinician behavior. Psychometric scales complement case reports, but existing scales have significant limitations.

Enantioselective reaction of -cyano imines: decarboxylative Mannich-type reaction with malonic acid half thioesters.

The enantioselective reaction of imines bearing a cyano group as an activating group with malonic acid half thioesters gave chiral cyanamide derivatives with high enantioselectivity. The density functional theory (DFT) calculation clarified the stereochemical outcome and importance of the -cyano group for imines.

[End-of-Life Medical Care for Cranial Nerve Diseases from Ethical and Legal Perspective].

After showing the basic knowledge of law, I examined the relation ship between law and ethics. Subsequently, I explained a related law about the end-of-life stage and neurological intractable diseases based on specific cases. I analyzed the structure of the guidelines for end-of-life and dementia guidelines, which have great significance in Japan.

The Principles of Revised Clinical Guidelines about Palliative Sedation Therapy of the Japanese Society for Palliative Medicine.

When the suffering of a terminally ill patient is intolerable and refractory, sedatives are sometimes used for symptom relief. To describe the main principles of revised Japanese clinical guidelines about palliative sedation therapy. Consensus methods using the Delphi technique were used.

[Withholding and withdrawing life-prolonging treatment--from the bioethical and legal viewpoints].

In Japan we have not reached an agreement on 'Withholding and Withdrawing Life-prolonging Treatment' among medical, bioethical and legal views. To achieve consensus on this issue, we should take several problems into consideration. They include: (1) Medical judgment; 'Is the patient in the end-stage of illness?' 'Is the futility of the treatment evident?' (2) Autonomy of the patient; 'Is the patient competent?' 'Is the Advanced Directive effective?' 'Is this the decision for the patient's best interest?' (3) Decision making by the family; 'Who is the most appropriate surrogate?' 'Does the decision reflect the patient's values?' or 'Is it for the patient's best interest?' (4) Procedural Justice; Enough communication, enough visibility and respecting the opinions by the third party are important to realize procedural justice.

[The significant of practical guideline in social context].

After drawing clinical practice guideline, we are going to face the significant of practice guideline in social context, both negative aspect and positive aspect. Negative aspect is the worry about misuse concerning medical malpractice lawsuits in courtroom. By analyzing the resent 3 Supreme Court decisions, I explain that practice guideline is the only one of recourses to determine medical negligence.