Because recent changes in medical care security policy have made clinical skills training difficult, even in teaching hospitals, training with suitable models and simulators is becoming essential for medical students to acquire clinical skills. On the basis of these changes, we performed a nationwide survey on the prevalence and application of clinical skills laboratories for clerkships in Japan. Registered questionnaires were sent to all medical schools in Japan （n＝80） in December 2012. The response forms were filled out by clinical instructors and by the staff responsible for the skills laboratory. The response rate was 94% （75 of 80 schools）. Seventy-one schools （95%） have already installed clinical skills laboratory; however, floor area and availability varied greatly among schools. Floor space ranged from 24 to 2,250 m2 （median, 214 m2）. The number of uses of the facility by medical students in the 2011 school year ranged from less than 100 to more than 10,000 （median, 1,402）. Forty-two schools （59%） had a resident director for the skills laboratory. Simulators of most universities （> 90%） were venopuncture simulators, lung-sound simulators, basic life support mannequins, heart-sound simulators, surgical suture trainers, and automated external defibrillator trainers, and all were frequently used. These results suggest considerable differences among schools in simulation-based learning environments during clinical clerkships. Although most medical schools in Japan have their own clinical skills laboratories, their size, service, and frequency of use vary greatly.

Objective: To clarify the reason why the target levels of low-density lipoprotein (LDL)-cholesterol are hardly attained.
Methods: The questionnaire was performed for 237 general practitioners on prescription of HMG-CoA reductase inhibitors (statins), just after the publication of “Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2007”.
Results: The responses could be summarized as 1) almost all doctors recognized the significance of target levels of LDL-cholesterol; 2) however, general physicians have such a recognition to a lesser extent, compared with cardiologists; 3) when prescribing statins, 66.2% of them had concerns about drug-drug interactions; 4) as the adverse events with statins, they listed creatine kinase (CK) elevations (86.5%), hepatic dysfunction (74.3%) and myalgias/rhabdomyolysis (70.9%); 5) in contrast, less than 20% of them listed the fulminant hepatic failure, gastrointestinal symptoms and fluctuation of blood glucose levels; 6) the threshold value of CK to discontinue statins was 500 IU/L in 44.4% and 200-300 IU/L in 39.6%; and 7) 78.5% of them believed that statins have the pleiotropic ability such a anti-inflammatory effect clinically, in addition to lipid-lowering.
Conclusions: It is important to serve the drug information about the safety of statins to the general practitioners for the management of hyperlipidemia, based on original articles.

To clarify the views and needs on Rx-to-OTC switches in patients afflicted with lifestyle-related diseases such as hypertension, diabetes and/or hyperlipidemia, our survey was conducted with 199 patients at a pharmacy in Tokyo, Japan.Of the 199 patients, 159 people were patients afflicted with lifestyle-related diseases.One hundred and ten patients afflicted with lifestyle-related diseases were seventy-year-old and older, and 149 of the patients have been to a hospital at least once in the past year.Thirty-six point five percent of the patients afflicted with lifestyle-related diseases replied that they wanted to use Rx-to-OTC switches when they had been ill and/or injured.The main reasons that they wanted to use Rx-to-OTC switches were “convenience” and “always the same drugs”.On the other hand, the main reason that they did not want to use Rx-to-OTC switches was “I want to have a detailed examination”.Twenty-three point nine percent of them replied that they wanted to switch their prescription drugs to Rx-to-OTC switches. We believe that the usage of Rx-to-OTC switches after the establishment of a support system to secure safety can be the answer to the issues of the rise in medical care expenditures and doctor shortage.

The occurrence of multiple supernumerary teeth in individuals without any associated syndrome is rare. In this report, a rare case of a 48-year-old woman who had an impacted supernumerary fourth molar in the bilateral mandibular ramus is described. She presented with a swelling in the left cheek region. Radiographic examination revealed an impacted supernumerary tooth in the left mandibular ramus with pericoronal resorption of the bone, suggesting peripheral inflammation. She also had an impacted supernumerary tooth on the right side. After administering an antibiotic and antiinflammatory drug, tooth extraction was performed under general anesthesia.

To investigate the effects of generational factors on the lives of medical students in the first and second years, we surveyed students about the frequency of problems and the seeking of advice.1) A questionnaire was distributed to first- and second-year students in January 2009 asking about problems regarding academic work, mental health, financial concerns, career options, physical wellness, and interpersonal relationships.2) About 70% of the students had sought advice regarding academic work and interpersonal relationships. Also, about 50% had sought advice regarding mental health.3) Students chose potential advisors depending on the type of problem; however, they preferred to consult with their classmates and upperclassmen. In addition, their parents played a role. In contrast, students rarely consulted with teachers.4) High percentages of first- and second-year medical students had various problems. Creating a support system to address these problems is important.

To accurately assess the clinical competencies of medical students at Fukushima Medical University, we have developed a novel online self–assessment system, which covers all goals in the "Model Core Curriculum for Medical Education in Japan." We added "Emergency," "Communication skills with staff," and "Simulation–based learning." Following their clinical clerkships, 79 sixth–year medical students assessed themselves and their clinical clerkships.
1)This novel online self–assessment system, consisting of 68 checklists in 15 fields, easily informs us of the actual conditions of clinical clerkships and students' confidence in their clinical competencies.
2)This internet–based self–assessment system revealed the current status and problems of clinical clerkships, prompting feedback to clinical instructors and members of the instruction committee.
3)Students felt "confident" or "confident to a certain degree" in most learning areas; however, simulation–based learning seems to be necessary in several areas, such as clinical skills, where feelings of shame or discomfort may be associated with patient care.
4)Students who had high total self–assessment scores evaluated clinical clerkships favorably. In contrast, students whose self–assessments frequently included "no learning experience" evaluated their clerkships negatively in the educational aspects of "skill" and "attitude."

　　The process of creating health promotion activities in the community was analyzed by means of document examination. The results showed that the process has four periods, namely, the preparation period, consensus period, planning-implementation period, and continuation period. Based on our results, we propose a general-purpose design for community resident-centered health promotion activities in areas with different characteristics.

We report the first case demonstrating an association between Kawasaki disease (KD) and erythema nodosum (EN). A 3-year-old girl presented with EN as an initial manifestation of KD. At the initial visit, she showed high fever of 40℃, injection of the oropharynx, cervical lymphadenopathy, and red-purple cutaneous nodules, particularly on the lower limbs. She complained of severe pain in the neck and cutaneous lesions. Initially, the development of EN was attributed to Salmonella spp infection, which was detected in stool culture. However, the patient did not respond to high-dose ampicillin/sulbactam to which the Salmonella spp is sensitive. Echocardiography performed as screening for fever of unknown origin revealed medium-sized aneurysms of the left anterior descending artery. EN masked the diagnosis of KD, and the patient developed a coronary artery lesion. KD should be considered in the differential diagnosis of refractory EN in pediatric patients.
Aneurysm ; Arteries ; Bacterial Infections ; Child, Preschool ; Coronary Vessels ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Erythema Nodosum ; Erythema ; Exanthema ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Lower Extremity ; Lymphatic Diseases ; Masks ; Mass Screening ; Mucocutaneous Lymph Node Syndrome ; Neck ; Oropharynx ; Salmonella ; Skin ; Subcutaneous Tissue

　　In recent years, favorable therapeutic outcomes have been reported for arterial injection chemoradiotherapy for tongue cancer. The present case involves an 80-year-old woman in our palliative care department who had high-grade, advanced tongue cancer. Because there was a request for surgery to prevent airway occlusion due to growth of the tumor, she was referred to our department in April 2009. As a treatment policy for controlling tumor growth in high-grade, advanced tongue cancer, arterial injection chemoradiotherapy was carried out through the superficial temporal artery, with a tongue artery catheter in place on both sides. Therapeutic effect was obtained, and it was possible to avoid airway occlusion through tumor regression. Dysphagia and dysphemia were improved, which in turn improved quality of life. In this case, there was an opportunity to carry out multidisciplinary team medicine, including support from the oral care and palliative care teams as part of the process of cancer therapy. Here, we present our findings in this case.