Introduction: Our school adopted team-based learning （TBL） in symptomatology classes for fourth-year students in 2010.
Method: This study examined the effects and problems of using a questionnaire survey involving students.
Results: The final scores of the students were distributed widely between approximately 65 to 90 points, indicating that TBL increased the spread of scores. The results of the survey showed that many students considered TBL to be a more effective approach than class-based learning, but most students showed an unfavorable attitude toward peer assessment. However, the results of multiple linear regression analysis showed no correlation between the survey results and final scores. The students who did not work together had better scores than students who did （p＝0.048）.
Discussion: The findings suggest that students’ scores after TBL are correlated with those after class-based teaching and that TBL helps improve students’ scores, especially those for case-study questions.

  The purpose of this study was to accumulate fundamental data for use in the future project for preventing or delaying institutionalization of the aged by clarifying the relationship between the Kihon Checklist and bone density. All the subjects were residents of the southern part of Akita Prefecture in the 65-74 age band. The Kihon Checklist was used. The women who marked the items on the list related to “intraoral conditions” tended to be low in bone density. Those who checked off the items related to “oral functions” -- the standard of judgment in determining the level of care needed - were inactive and depressed.   Since bone density was an indicator of whether the elderly women were in need of nursing care, we thought it of paramount importance to encourage them to participate in the screening for osteoporosis on a regular basis and to take measures to maintain or improve bone density.

In the previous report, we concluded that chances are very slim for Salithion and Sumithion to concentrate in rabbits as these organophosphorous compounds are excreted quickly. This conclusion was inferentially drawn from the results of measurements of concentration of Salithion and Sumithion residues in the blood after experimental exposures of rabbits to the pesticides.
In the present report, we will discuss the same toxicological problem based on our findings in a series of experiments using rabbits with hepatic disturbances induced by carbon tetrachloride (CCl₄).
Rabbits were divided into three groups. One consists of rabbits having light hepatic disorder. They were subcutaneously injected with 0.1ml/kg of 20% CCl4 olive oil for three days consecutively. Under the second group come rabbits with moderate liver disturbance caused by the injection of 0.3 ml/kg of 20% CCl₄ olive oil. The injection was also made for three days. The remaining group is the control group.
These rabbits were administered orally with 5mg/kg and 20mg/kg of Smithion for three days running.
The examination covered (1) Sumithion residue level in the blood, (2) PNMC level in urine, (3) hepatic function (ChE, GOT, GPT, BSP, Al-P, BUN), (4) urinalysis and (5) histopathological examination of the liver and the kidney. The results of these tests were studied in comparison with those of the control group.
The following is a summary of our conclusion:
1) In the control group, Sumithion residues in the blood disappeared quickly, and could not be detected 72 hours after administration.
2) As far as the disappearance of Sumithion and the excretion of PNMC are concerned, there was no significant difference between the control and the light and moderate liver disturbance groups of rabbits.
3) In the rabbits with CCl₄-induced liver disturbances, it was noted that the administration of Sumithion impeded serum and red-cell ChE activities to a remarkable extent, and delayed the recovery of the liver function.
4) However, the liver disturbance did not deteriorate. The histological observation of the liver and the kidney did not reveal any abnormality due to the administration of Sumithion, either.

Personal lifestyles constitute one of the strategic frontiers of preventive medicine. We carried out a survey of eating habits of people in three rural communities in the southern part of Akita Prefecture, where fundamental health screening programs have been implemented regularly. Differences in eating habits between men and women and between age groups were found. The health status of the examinees was judged by using data on blood pressure, obesity and lipid levels measured at the latest health checkup.
To find a correlation between eating habits and physical health status, the frequency of illness was examined according to the number of times of eating various kinds of food. It was found that with age, people take in fish and shellfish, cow's milk, beans, vegetables, Japanese confections and soup more frequently and eat less meat. The incidence of hypertension varied by age and sex, but was higher in those who eat less soup, pickles and milk. Likewise, abnormally high levels of total serum cholesterol were found in women who eat meat, eggs and greasy food less than twice a week. It was thought that those hypertensives and those with high cholesterol values are cuttingdown on their intake of those foods of their own accord. Therefore, we would like to point out that, in the secondary prevention setting, physicians and other health care providers should know in advance whether their patients are putting themselves on a restricted diet or not.
When the average serum lipid values were examined according to the number of times of eating meat or fish and shellfish per day, it was found that men aged 70 years or above who eat those foods more than once every day have high HDL cholesterol values and that these values significantly vary depending on the kind of meat. These findings suggested that persons of advanced age who eat well and who are not particular about their food are full of vitality. This could serve as an important point in the care of the aged with serum lipid abnormalities.
A study of evacuation and its relation to vegetable intake showed that the less the frequency of bowel movements, the smaller the amount of vegetable intake. There was a significant difference in the frequency of evacuation between vegetable eaters and those who do not consume an adequate amount of fiber.

  In view of the situation where an increasing number of old women as well as old men have health problems associated with drinking, some measures should be taken in terms of setting sensible limits of alcoholic intake for these people to keep to, the Report of Kenko (Health) Nippon 21 for 2011 warned. It also suggested that further studies be made to amass necessary data in order to introduce effective measures and give a right assessment to the situation.
  The present study was carried out with the aim of providing fundamental pieces of information usable in primary prevention of alcohol-related health problems among the aged. For this purpose, we looked into the drinking habits as well as the numerical data of vital and liver functions tests of old people in a rural area in Yokote, Akita Prefecture. A total of 448 old people (206 men, 242 women) were involved in this study. Nineteen items out of 25 in the Kihon-Checklist, which was designed to reduce the need for nursing care, revealed notable decreases in vital functions in those men who took in over 21 grams of alcohol per day. Of those men specially categorized as individuals who are 65 and older and who are regarded as very likely to need nursing care in the near future, 88.9% took in 21 grams of alcohol. In women, there was no relation between drinking habits, BMI and liver functions. However, it was found that daily alcoholic consumption was greater in those specially categorized group of women at high risk for institutional care than in the other women.
  Our study made it clear that drinking habits, which were found to bear on liver and vital functions, could serve as a yardstick for judging whether the old people are at high risk for institutional care. We concluded that it is necessary to spread the knowledge about the adverse effects of alcohol among the elderly and advise them to act their age and drink in moderation even before they enter advanced age.

We investigated the outcomes of nephron-sparing surgery in patients with small renal cell carcinomas by retrospectively reviewing the records of 20 elective cases of nephron-sparing surgery performed from 1994 to 2003. All patients had low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas. There were no significant differences between mean preoperative serum creatinine levels and postoperative levels. Nephron-sparing surgery may be safe and curative treatment for low pathologic stage, localized, unilateral tumors smaller than 4 cm and sporadic renal cell carcinomas.
Surgical aspects ; Carcinoma, Renal Cell ; Nephron brand of racepinephrine hydrochloride ; seconds ; Small

The Medical Education Development Center has organized seminars and workshops for medical education 30 times from 2000 through 2008 throughout Japan. The participants have numbered more than 3200 and have included educators, physicians, students, and simulated patients. The topics of seminars and workshops have included problem-based learning tutorial systems, medical interview skills, objective structured clinical examinations, evidence-based medicine, coaching technology, simulations, and community medicine in response to educational needs. A questionnaire survey of 1793 participants of the 11th to 30th seminars and workshops (response rate, 85.6%) showed a high degree of satisfaction (4.33±0.13 of 5 points). Invited lecturers and directors from throughout the country often organized these workshops. The results of workshops are reported in our annual monograph, "Trends in Medical Education."

A survey was conducted to better understand the current status of training of simulated and standardized patients (SP) in medical education and training protocol of SP training at each site, and to determine the future planning of the committee
1) Methods: A series of questions regarding the SP and SP training was sent to all 80 medical schools in Japan.
2) Results: Responses were received from 68 medical school (85%). According to the survey result, 43 medical schools (63%) trained their own SP. The total numbers of SP reported in this survey were 1,036 with ratio of male to female 1:3. The average numbers of SP at each medical school were 24 (range 5 to 87). SP training protocols were included basic training (88%) and to prepare common achievement test OSCE (84%), classes (74%) and advanced OSCE(60%). Only 6 medical school (14%) had the systematic curriculum for SP training.
3) Conclusion: To produce standardized, accurate SP training for medical education, the committee recommends to establish the standard curriculum and portrayal requirements for SP training.

This article describes the end of life of seven people with amyotrophic lateral sclerosis (ALS) under the care of a hospice. The reasons for admission to hospice were for the management of distressing symptoms and the support of families who were unable to continue care at home because of the increased burden of care and/or illness of families. The sufferings experienced by the patients with ALS included disability due to muscle weakness(100%), pain(100%), discomfort (100%), dyspnea (71%), difficulties in communication (71%), drooling (43%), insomnia (43%), loneliness (43%), swallowing difficulties (28%), clenching the mucosa inside the cheek (28%), anxiety (28%), the perception of being a burden to the family (28%), and concerns as to why they had developed ALS (28%). Opioid medication was effective in the management of dyspnea, pain and discomfort. The results showed that special attention should be paid to frequent changing of the patient's position during nursing care, including the passive movement of joints and massage. The use of communication aids was essential to allow people with ALS to communicate effectively and, together with support of joy of the patients and family, the quality of life could be improved. End of life care within a hospice is a useful alternative option for persons with ALS, extending hospice care in Japan from people with advanced cancer to other disease groups. Palliat Care Res 2010; 5(2): 137-143

1．The basic training curriculum for simulated and standardized patients （SPs） was provided by the 16th Medical Simulation Committee based upon a nationwide field survey that was conducted by the committee in 2009 and other data.
2．The curriculum consists of 3 essential programs: interpersonal communication, medical education involving SPs, and the medical interview.
3．The medical interview program was composed of basic issues, comprehension of scenarios, acting role and performance, and feedback and assessment.
4．The training facilities or institutions were recommended to properly assess the performance quality of SPs in the educational setting by means of a specific and clearly defined evaluation method.