Recently in Japan, "transition of care" cases, in which patients are transferred from a medical institution that had once provided medical care to a new one and the medical care provider is therefore changed, are increasing. However, the concept of "transition of care" and "undesirable outcomes in patients accompanied by care transition" have been studied very little in Japan. The concept of "transition of care" consists of factors such as patient background (age, underlying disease, and family's caregiving ability), transfer of clinical information, and tools to transfer clinical information. In Europe and the USA, undesirable outcomes accompanied by care transition, such as "medicamentous adverse events", "clinical examination data taken during hospitalization are not confirmed", and "medical care planned for a patient is not implemented", are reported to have occurred for 19% to 50% of patients who had been discharged from hospitals and transferred to clinics. It is also necessary to understand the state of care transition in Japan and investigate countermeasures compatible with the Japanese medical care system.

Background: Internal medicine physicians are able to convert to "general practitioners" in the future.Objective: To examine factors related with "career conversion to a general practitioner" conceived by hospital internal-medicine physicians specializing in organs/regions.Materials and Method: A semi-structured interview was conducted for 20 internal-medicine physicians with their consent from November 2014 to November 2015. The verbatim records were analyzed with the modified grounded theory approach.Results: The facilitating factors for career conversion consisted of "a career plan where characteristics of a general practitioner can be utilized", "high-quality training that combines practical conditions", and "diverse ways of working and a specialist-licentiate who has opportunities for learning".On the other hand, the suppressive factors consisted of "a lack of understanding of general practitioners", "difficulties associated with re-training", and "a feeling of resistance toward comprehensiveness of general practitioners".Conclusions: Career conversion to general practitioner by qualified internal-medicine physicians was suggested to be promoted by enhancing the meaningfulness of the general practitioner license, the training circumstances, and ensuring the professionalism and financial aspects of physician life.

The earlier the diagnosis of acute type A aortic dissection is made, the more frequent the complications of aortic root destruction and/or a compromised coronary artery are encountered. Only aortography is diagnostic in these lesions, however, recently this modality tends to be avoided in order to try to improve the survival rate of the patients by obtaining diagnosis by noninvasive modalities. Therefore, contrast-enhanced CT scans in 49 patients with aortic dissection were analyzed in order to detect the slightest signs suggesting aortic root lesions. In 4 of the 6 cases in which intimal flap was detected in the aortic root by CT and in 2 of the 14 cases with an aortic root more than 35mm in diameter, aortic root reconstruction and/or concomitant CABG were neccessary for the repair of the destroyed aortic root. The aortic root diameter was more than 40mm in 8 of 9 patients with aortic root destruction, with a mean value of 45.6±3.6mm (p<0.01). In summary, detection of a septum in the aortic root and/or an aortic root dilated more than 40mm on CT were important signs suggesting the dissection extending to the aortic sinus combined with aortic root destruction. In such cases aortic root reconstruction and/or concomitant CABG may be necessary.