Teaching hospitals play an increasingly important role in clinical training, and improvement of the education system is required. To effectively utilize limited human and material resources for clinical education and to enhance clinical education and medicine treatment throughout a region, cooperation between hospitals is essential. However, cooperation for clinical education training beyond prefectures or training hospitals cannot be said to be sufficient. The Kisogawa Medical Conference, a collaborative system of 5 training hospitals located around the Kiso River estuary, held medical lectures, hands–on seminars, and joint–hospital case conferences. Cooperation in medical education training and exchanges beyond prefectures and training hospitals is expected to lead to substantial improvements, not only in medical education training, but also in medical care throughout a region.

  To respond to the physician shortage, the capacity of medical schools has been increased through selective admission of student to practice in medically underserved areas; however, neither a system nor a curriculum for such students has been established. At Nagoya University, selected students have been admitted, and the division of Education for Community–Oriented Medicine was established in fiscal year 2009. We have introduced special curricula for these students, such as a seminar for community–oriented medicine, training for medical research, local hospital tours, and a special interprofessional education course. In fiscal year 2013, community medicine is expected to be implemented as a compulsory subject in the 4th year curriculum. For the education of students selected to practice in medically underserved areas, we believe that older students serving as role models and cooperation with other organizations and community are important.

　In the coming ″Super-aging society″ , collaboration between medical professionals and health workers in home-care will be critical. Thus, undergraduate interprofessional education is important for the improvement of a collaborative attitude. We ran a 2-day IPE program for a medical and a rehabilitation student focused on collaboration for patients who have chronic diseases and problems in Activities of Daily Life (ADL) . As a result, one showed marked improvement in ADL while the other did not. Students learned not only roles and perceptions of other professionals but also a sense of worth and an appreciation of the difficulty of patient-centered home-care.

The influence of aerobic and anaerobic components of muscular endurance on the lower limbs, on sprint ability while under conditions of muscular fatigue, was investigated. Fifteen track and field athletes (400 m sprinters, decathletes and middle distance runners) participated in the study in which running and sprinting movements at respective points (360 m and 50 m) along two distance conditions (400 m and 80 m, respectively), were filmed by high-speed video camera. Running speeds at each point were computed from the film analysis. The running speed at 360 m point was defined as the speed under fatigue, while the running speed at the 50m point was defined as the maximal speed. Further, the rate between speed under fatigue and maximal speed was defined as %Max. Speed. Maximal O₂ intake, O₂ debt and isokinetic muscular endurance were measured.
The results were summarized as follows :
1) Oxygen debt showed significant correlation with the average speed during 400m running (r=0.546 ; p<0.05), but not with the speed under fatigue (r=0.388 ; p>0.05) .
2) Speed under fatigue was positively correlated with muscular endurance of hip flexion and extension (r=0.683 ; p<0.01, r=0.572 ; p<0.05) .
3) Percent Max. Speed was negatively correlated with the maximal speed (r = -0.643 ; p <0.01) and positively correlated with the muscular endurance of hip flexion and extension, and knee flexion (r=0.640 ; p <0.05, r=0.517 ; p<0.05, r=0.646 ; p<0.01) .
These results suggest that; raising %Max. Speed to improve the muscular endurance of lower limbs and, to improve aerobic ability by developing the number of capillaries in the muscle, is important.

  In scenarios developed by a multidisciplinary faculty for interprofessional education, practical problems that emerged included: “medical incident” and “shortage of medical resources” from the perspective of patient and families,” and “information sharing,” “evaluation and feedback,” and “insufficient feeling of accomplishment” from the perspective of health-care professionals. Discussions identified “interprofessional collaboration,” “mutual understanding for professionalism,” and “embodiment of professional culture” as key words for problem solving. Finally, scenarios were developed in the hospital, home-care, nursing, or community care settings that referred to 2 themes, “end of life” and “dementia.” Pilot case studies performed with health care professionals demonstrated the utility of the scenarios and the effectiveness of interprofessional education.

1) A program entitled Doc MMC was broadcast on FM Mie, a local FM radio station.“The Doc MMC Declaration”was performed on this program by residents.
2) The declarations were classified into six groups: “Affection, ”“Contribution to Community Medicine, ”“Knowledge and Skill, ”“Special Training Course Selection or Self-Activation, ”and “Others.”
3) This kind of broadcasting may enhance the motivation of residents and facilitate the understanding of medical issues by the community.

1)A workshop to promote interprofessional health–care collaboration in the community is reported.
2)The three topics discussed were: "the needs of an interprofessional network in the community," "barriers that can prevent the promotion of an interprofessional network in the community," and "strategies to overcome the barriers."
3)The critical issues identified were, communication, information sharing, and leadership. Working to improve the health–care system and clarifying and promoting the significance of an interprofessional network were also identified as critical issues.

In 2004 a program of community health and medicine was included in the national residency system. However, the contents and achievements of this program have not been adequately studied. We surveyed residents, program directors, and collaborating facilities for clinical training in community medicine in the Tohoku–Hokuriku region of Japan about the contents, practices, training period, curriculum development, and other aspects of the program.
1)We conducted a survey of 230 residents who had completed the program, 82 program managers, and 101 collaborating facilities.
2)The survey consisted of surveys of residents (survey 1), of program directors (survey 2), and of collaborating facilities (survey 3) and asked about the programs' consistency with the training objectives of the Ministry of Health, Labour and Welfare and satisfaction with community medicine.
3)Approximately 70% of residents, program managers, and collaborating facilities believed the training period for community medicine is appropriate.
4)Furthermore, 69.1% of residents, 65.5% of program directors, and 85.2% of facilities believed that the community medicine program in the national system was important or very important.
5)Training programs should be enhanced so that residents "understand and practice health care in outlying and rural areas" and to increase active involvement of program directors.

　The WHO reported the importance of IPE (Interprofessional Education) in order to implement team-based medicine smoothly. Some Japanese medical educational institutes presented their IPE programs, which involved real patients, but most IPE programs used scenario-based or standardized patients. Moreover, few reports showed IPE programs for diabetic patient education. We created a new program, called the "Diabetes education class IPE" . Participants were 2 medical, 4 nursing, 4 pharmacy, and 3 dietician students. The students experienced the planning and management of and reflection on diabetes education classes. As a result of reflection, the "Diabetes education class IPE" was viewed as a useful IPE program.

Objectives: To evaluate the efficacy of tegafur–uracil (UFT), a prodrug of 5-fluorouracil, plus cisplatin and dexamethasone in patients with docetaxel-refractory prostate cancers.

Methods: Twenty-five patients with docetaxel-refractory prostate cancer were administered oral UFT plus intravenous cisplatin (UFT-P therapy) and dexamethasone. Treatment responses were assessed monthly via prostate-specific antigen (PSA) level measurements. Treatment-related adverse events and overall survival were also assessed.

Results: UFT-P therapy resulted in decreased PSA levels in 14 (56%) patients and increased PSA levels in 11 (44%). In patients with increased PSA levels, 7 (64%) of the 11 patients displayed decreased PSA doubling times. The UFT-P therapy response rate was 84% (21/25 patients). Imaging studies revealed that tumor shrinkage during UFT-P therapy occurred in 1 patient in whom bilateral hydronephrosis caused by lymph node metastasis improved. The median survival time from docetaxel initiation was 36 months. In UFT-P-treated patients, the median PSA progression and overall survival times were 6 and 14 months, respectively. UFT-P treatment-related adverse events were mild diarrhea, general fatigue, and anorexia. Treatment was not discontinued for any of the patients. UFT-P therapy did not cause serious hepatic or renal dysfunction or pancytopenia.

Conclusions: UFT-P therapy is a safe and effective treatment for patients with docetaxel-refractory prostate cancer, although large-scale, multicenter, prospective studies are needed to validate these findings.