Since 1993, we have used a clinical clerkship method in an attempt to improve the undergraduate clinical training in our department. At first, the students were given the opportunity to learn adequate basic clinical procedures (levels 1 to 3), but data on the effect of their training were lacking. Therefore, we conducted a survey to obtain the necessary information. Twenty-nine students (29 % of students in the sixth academic year) participated and wrote their survey reports at the end of the course. The reports were designed to evaluate their problem-solving skills and the effects of self-directed learning in clinical anesthesia and to obtain an overall impression of the training. The results revealed that the educational effect was insufficient for almost all students who participated because they were unable to fully solve the problems of anesthetic management from either a pathophysiologic or pathobiochemical standpoint. From these results and our further experiences from 1994 through 1996, we decided to reform our educational procedures. The important improvements are as follows. 1) Trainees must record the anesthesia course during the assigned anesthetic case and participate in the postoperative ward discussion. 2) A member of the teaching staff must discuss ways to manage and solve problems with trainees at the end of each case. 3) After the discussion, trainees must write a report about how and what they have learned.

To investigate the effect of intense exercise on immunological factors in saliva, we measured secretory immunoglobulin A (sIgA), lactoferrin and fibronectin. We used a reliable saliva collection method that has already been reported. Timed saliva samples were obtained from 16 healthy young males. Samples were collected before, immediately after, 1 day after and 5 days after endurance running (42.195 km) . The concentrations (μg/ml) of sIgA, lactoferrin and fibronectin were measured by ELISA, and the secretion rates (μg/min) of each were calculated. Immediately after the exercise, the concentration of total protein in saliva increased significantly, but the sIgA secretion rate decreased to 53%. The secretion rates of both lactoferrin and fibronectin did not change significantly. The local immune system plays an important role in mucosal surface defense against upper respiratory tract infection. The sIgA level in the oral cavity was temporarily decreased after intense exercise. A decreased sIgA secretion rate might partly explain the increased susceptibility to upper respiratory tract infection after endurance exercise.

It is generally accepted that visually impaired individuals generally have a low aerobic capacity, which may be partly attributed to a lack of physical activity, and have hypothesized that their response to exercise may differ from that of normal-sighted people. In this study, we investigated the effect of exercise on local immunity in the oral cavity in 24 visually impaired males (n=8 ; totally blind group, n=16 ; partially sighted group) and 8 normal-sighted males. The subjects performed submaximal graded bicycle ergometer exercise to an intensity of 75% heart rate max for 12 min. Before and immediately after exercise, we collected timed saliva samples and measured secretory immunoglobulin A (sIgA) .
The totally blind group had lower levels of aerobic capacity and a lower sIgA secretion rate compared to the partially sighted and sighted groups. Immediately after exercise, the sIgA secretion rate tended to increase in the totally blind group.
It is suggested that the exercise-induced response of local immunity in the totally blind group differed from that in the other groups.

At Anjo Kosei Hospital, patients receive injectable medication for diabetes treatment and devices for self-monitoring of blood glucose as in-hospital prescriptions. Pharmacists manage prescriptions according to established protocols when there is over- or under-prescribing. In this study, we retrospectively examined outpatient prescriptions for patients attending endocrinology and diabetology from January 2014 to June 2015 (before protocol implementation) and from July 2015 to December 2020 (after protocol implementation) to evaluate the usefulness of protocol-based supporting prescription by pharmacists. Changing prescriptions based on the protocol simplified prescription queries in 661 of 721 cases (91.7%), and significantly decreased the rate of unplanned doctor visits after the introduction of the protocol (p<0.05). Optimization of prescriptions through protocol-based assistance in prescribing is expected to reduce the burden on physicians, patients, and pharmacists by reducing the number of formal inquiries for questionable prescriptions and the number of unplanned doctor visits.