Introduction: Differences in residency programs between large and small hospitals have not been shown in Japan.
Method: We performed a qualitative analysis of focus-group interviews of residents in community hospitals to investigate characteristics and problems of their residency programs.
Results: We found that residents in community hospitals treated difficult patients with the help of the medical staff; this cooperation was one of the most important characteristics of residency programs. We also found that residents tended to have less experience in emergency medicine and several other specialties.
Discussion: We found that residents in community hospitals learned how to treat difficult patients with the help of medical staff by means of a biopsychosocial model.

Spontaneous reporting system of adverse reactions (ADRs) is indispensable to secure drug safety. Although good systems of western countries are well-known in Japan, it seems that the French pharmacovigilance system is not familiar, as compared with the yellow-card system in the UK and the MEDWatch program in the US.
This report outlines various features of the French system according to our information collected by a visit to the French medicines agency and one of the regional centers. The “good pharmacovigilance practices, ” enforced by the agency in 1995, is used as a reference.
Notable features are summarized as follows : (1) decentralized activities by the 31 regional centers collecting spontaneous ADR reports from healthcare professionals, (2) centralized EDP-system retaining ADR data, (3) official decision-making process called “inquiry”, which opens when a signal of safety issues comes up, and synthesizes a consensus and proposal on necessary measures, (4) bidirectional communication between the regional centers and prescribers, reporting ADRs and providing safety information by Q & A, (5) collaboration of specialist committees and pharmaceutical companies with the above elements, and so forth.
The system is characterized by these elements constructing collectively an effctive system to prevent ADRs and reduce the seriousness. These findings will be helpful, even in Japan, when subjects for improvement of a reporting system are discussed.

Introduction: This study examined the effectiveness of the modified Hospital Elder Life Program (HELP) for preventing delirium, which was adjusted to be used in acute internal medicine wards at general community hospitals in Japan.Methods: The pre-intervention group consisted of 751 patients aged 70 years or older hospitalized at Nishiyodo Hospital and Amagasaki Medical Co-op Hospital between January and July 2013. The post-intervention group consisted of 775 patients aged 70 years or older hospitalized between March and July 2017 and between October and December 2017. To address risk factors for delirium, a multicomponent intervention (modified HELP) consisting of the following was implemented: handing out pamphlets, orientation to maintain activity levels, sleep improvement, early initiation of rehabilitation, provision of glasses, hearing aids, and dentures, and the termination of continuous intravenous infusion. The Delirium Screening Tool was used to calculate the percentage of inpatients who developed delirium.Results: Of the 751 patients in the pre-intervention group, 108 (14.4%) developed delirium and 88 (11.4%) of the 775 patients in the post-intervention group exhibited delirium (odds ratio: 0.70; 95% confidence interval: 0.48-1.01; p=0.06).Conclusion: The modified HELP, adjusted for use in Japan, did not significantly reduce the rate of delirium during hospitalization. Therefore, a more universal intervention method is needed in the future.

Carpal tunnel syndrome is a common condition caused by compression of the median nerve. Patients usually present with numbness and pain along the distribution of the median nerve in the hand. We report 2 cases of carpal tunnel syndrome successfully treated with kakkonto after their pattern diagnosis. We treated a 57-year-­old women and a 59-­year-­old man. Two patients presented with hand pain and numbness and were diagnosed with carpal tunnel syndrome. Kakkonto treatment was successfully in two cases. We observed that median nerve compression persisted in these patients even after disappearance of numbness and pain ; therefore, we recommended operative management. The 2 patients underwent an operation for carpal tunnel syndrome. Kakkonto can be considered useful palliative treatment before considering operative management for numbness and pain in the patients with carpal tunnel syndrome.

Boi-ogi-to is frequently prescribed to relieve pain for osteoarthritis in the therapy of Kampo formulation. However, it has been pointed out that the evaluation of this formulation differs among the patients. It is often showed lower effectiveness and/or non-effectiveness in the patients with advanced roentgenographic deformity, obesity, and suffering from more severe pain.
We thought that it was resulted from ingoring the abdominal-sho (symptom). Therefore, in this study, we defined the abdominal-sho of Boi-ogi-to as “frog abdominal-sho”, and administered Boi-ogi-to to 17 patients with osteoarthritis of the knee who had frog abdominal sho. As a result, in the patients with frog abdominal-sho, the formulation was moderately or even better effective in relieving pain in 77% of these patients. It was acknowledged that the effect was independent of the severity of pain, the degree of obesity, and whether the roentgenographic deformity was slight or moderate.

1) We reported recent movement to graduate entry program (GEP) of medical education curriculum in the UK by both interviewing faculty members who are in charge of GEP and doing literature review.
2) In GEP, we may be able to make better doctors in short term.However, as long term outcome is not known so far, further discussion is necessary.
3) Many contents can be improved by just curriculum change, not by introducing GEP.Besides it can be said that GEP can make diverse doctors.

Background: Globalization urges us to discuss rationale and policy towards establishing a medical education accrediting body in Japan. Experience of General Medical Council （GMC） suggests us some useful lessons.
Method: Based on our visits and investigation into in GMC, we inquire how Quality Assurance （QA） was introduced in UK with what incentives and how QA has brought reforms in the medical schools in UK.
Result: Since 2003, GMC has changed its policy for QA from ‘inspection’ to ‘dialogue’. Dialogical QA asks a medical school to think critically of their education and consider vigorous actions for further improvements.
Discussion: Implications from the experience of GMC are: 1.QA process in GMC makes medical schools take robust steps towards changes, 2. Sharing the rational and policy for QA created the solid base for its effective implementation, 3. There are possible difficulties in establishing structure to do an enormous amount of coordinating work, which is necessary for constructing ‘dialogue with medical schools’.

BACKGROUND: In order to investigate transmission route of Yersinia pseudotuberculosis infection in Korea, we tried epidemiological study among human strains, mountain spring water strain and wild mouse strain which were isolated in north eastern area of Seoul on spring in 1996. METHODS: Plasmid profile (Restriction Endonuclease Analysis of Virulence Plasmid DNA analysis: REAP) assay in addition to serotyping were performed among human strains, mountain spring water strain and wild mouse strains. RESULTS: All isolates were the same O serotype of 4b and the same REAP pattern of type D. CONCLUSION: These results suggested that wild mice (especially Apodemus agrarius) were one of main reservoir of Y. pseudotuberculosis in Korea and their fecal material might contaminate mountain spring water. Most of human infections of Y. pseudotuberculosis were originated from drinking of contaminated mountain spring waters in Korea.
Animals ; DNA* ; Drinking ; Epidemiologic Studies* ; Epidemiology ; Humans ; Korea ; Mice ; Murinae ; Plasmids* ; Seoul ; Serotyping ; Virulence ; Yersinia pseudotuberculosis* ; Yersinia*

It is theoretically thought that Paeoniae Radix (shakuyaku) has a sour taste and astringent action in traditional Chinese medicine. To examine the practical taste of shakuyaku, 12 volunteers sampled the decoction of Paeoniae Radix Rubra (sekishaku) and Paeoniae Radix Alba (byakushaku). Each volunteer determined how sekishaku and byakushaku taste among “five tastes” : sweet, salty, bitter, sour, or spicy. Most volunteers chose bitter taste and none of them chose sour taste as the foremost taste of shakuyaku. At least in the modern age, shakuyaku may have little sour taste. In this article we discussed the astringent action and the muscle relaxant action of shakuyaku with reference to the sour taste.

STUDY DESIGN: Observational cohort study. PURPOSE: To assess the surgical outcomes of posterior decompression and fusion for cervical myelopathy in patients with athetoid cerebral palsy. OVERVIEW OF LITERATURE: Patients with athetoid cerebral palsy demonstrate involuntary movements and develop severe cervical spondylosis with kyphosis. In these patients, surgery is often performed at an early age because of myelopathy. A few studies have reported about the long-term outcomes of surgical treatment; however, they contain insufficient information. METHODS: From 2003 to 2008, 13 patients with cervical myelopathy due to athetoid cerebral palsy underwent posterior fusion surgery and were included in this study. The Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), C2–7 angle on radiography, and need for additional surgical treatment were examined at 1 and 5 years postoperatively. RESULTS: The mean C2–7 angle was −10.5°±21.1° preoperatively and was corrected to −2.9°±13.5° immediately postoperatively. This improvement was maintained for 5 years. The JOA score was 9.5±2.5 preoperatively and 12.2±1.7 at the 5-year follow-up. NDI was 17±6.9 preoperatively and 16±7.5 at the 5-year follow-up. Patient satisfaction with surgery on a 100-point scale was 62.2±22.5 at the 5-year follow-up. Three patients needed additional surgery for loosening of screws. These results demonstrate good surgical outcomes for posterior fusion at 5 years. CONCLUSIONS: Posterior decompression and fusion should be considered a viable option for cervical myelopathy in patients with athetoid cerebral palsy.
Asian Continental Ancestry Group ; Cerebral Palsy* ; Cohort Studies ; Decompression ; Dyskinesias ; Follow-Up Studies* ; Humans ; Kyphosis ; Neck ; Patient Satisfaction ; Radiography ; Spinal Cord Diseases* ; Spine ; Spondylosis