Currently, the international environment surrounding traditional medicine, including acupuncture and moxibustion, is changing faster than we can imagine. In recent years there are some Far East Asian countries that have registered the classical medical books of traditional medicine and a part of traditional medicines in their own countries to the Memory of the World and the Intangible Cultural Heritage in UNESCO. In addition, preparations to include traditional medicine in ICD-11 have been carried out with revision of ICD-10 in WHO. Furthermore, the working of international standardization of traditional medicine of Far East Asia is underway in ISO. Also WFAS is working on the international standardization of acupuncture and moxibustion in an official relationship with WHO. Furthermore, genetic resources and traditional knowledge related to traditional medicine have been discussed in CBD. The matters concerning traditional medicine have been discussed separately elsewhere in a wide variety of international organizations such as WIPO, WTO/TRIPS and FAO.
In this panel discussion, firstly, we outlined the main points about the protection of traditional knowledge by CBD and the Nagoya Protocol, clarified the current status of discussions in WIPO about traditional medicine and registration of traditional knowledge under the Intangible Cultural Heritage in UNESCO, and examined future protection of traditional knowledge of acupuncture and moxibustion. Secondly, we summarized the current status and progress of the international standardization of acupuncture and moxibustion driven by WFAS as commissioned by WHO, clarified the viewpoint of JSAM about problems with the efforts of WFAS for the international standardization of acupuncture and moxibustion, and discussed the relationship of the international standardization of acupuncture and moxibustion in WFAS and ISO. Finally, we summarized the progress of the international standardization of acupuncture and moxibustion from the 1980s when international standardization of acupuncture and moxibustion was first initiated by WHO up until the present when international standardization of acupuncture and moxibustion is included in ISO/TC249, surveyed the present situation of the international standardization of traditional medicine in the countries that are leading the international standardization of acupuncture and moxibustion, and discussed about the aspects of the struggle for supremacy lurking behind the international standardization of traditional medicine and the issues associated with the future of the international standardization of traditional medicine.

We conducted a national survey to examine the status of programs to teach evidence-based medicine (EBM) to undergraduates in Japan. Our survey specifically focused on four areas: 1) recognition of a need to teach EBM, 2) the present status of programs to teach EBM to undergraduates, 3) details of the timing of existing EBM teaching programs and of departments responsible for it. Sixty-four schools (80%) responded. Nearly all respondents agreed that EBM should be taught, and most agreed that it should be taught both before and after graduation. Most respondents stated that departments must collaborate when preparing to teach EBM. At the time of the survey, 22 medical schools (34%) had already started programs to teach EBM and 28 (42%) were planning to do so. Existing programs mainly targeted 4th-year students, but the department responsible for the programs varied among schools. Further evaluation of the effectiveness of existing programs is now needed.

This study explored the general public's perception of the clinical competence of residents. Methods: Individual interviews of laypersons, medical students, and residents and focus-group interviews of residents were conducted. Results: Individual interviews revealed the belief that residents acquired various clinical skills immediately after passing the national examination for medical practitioners. These skills included: assessment of the need for referrals, on-call jobs for after-hours and emergency services, interpreting X-ray films, performing cardiopulmonary resuscitation, performing surgery for appendicitis, and treating bone fractures and joint dislocations. Focus-group interviews revealed differences between residents and laypersons in the perception of residents' clinical skills. These skills included: general knowledge of diseases and medications, guidance about lifestyle after discharge, physical examinations, explanation of treatment, diagnostic imaging, and knowledge of or expertise in other medical professions. Conclusion: Laypersons and medical personnel have different perceptions about the clinical competence of residents.

Introduction : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.
Methods : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.
Results : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).
Conclusion : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

Background: Although community-based training is included in medical undergraduate education in Japan, little assessment of the outcomes of community-based education programs has been performed. The aim of this study was to investigate the outcomes of a community-based education program using a mixed method.
Methods: The study design utilized both qualitative and quantitative methods (mixed method). The subjects (n = 278) were fifth-grade medical students who were involved in the program from 2008 to 2010 inclusive. We collected two types of data: a six-item pre-and-post questionnaire (quantitative) and an open-ended questionnaire (qualitative) to evaluate the impressions this experience left on the students.
Results: Pre-and-post questionnaires were completed by 263 (95%) of 278 subjects; on all items, the scores of the post- data were significantly higher than that of pre- data (P < 0.001). From the responses given by 139 respondents (total 181, 77%) in the open-ended questionnaire survey, 10 themes were extracted: 1. Inter-professional cooperation; 2. Role and cooperation among university hospitals, community hospitals, clinics, and welfare facilities; 3. Patient-centered medicine; 4. Trust-based relationships; 5. Competency in general medicine; 6. Professionalism; 7. Medical management; 8. Communication; 9. Common diseases; and 10. Long-term care.
Conclusions: We found that medical students gained four major perspectives from their experiences: Inter-professional cooperation, trust based relationships, roles of community hospitals and clinics, and patient-centered medicine, respectively. Our findings suggest this program contributed significantly to their understanding of community medicine.

Purpose: The purpose of this study was to evaluate the cone-beam computed tomographic (CBCT) imaging and histopathological characteristics of osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ). Materials and Methods: Ten surgical specimens from segmental mandibulectomy (3 ORN and 7 MRONJ) were analyzed using CBCT. The CBCT parameters were as follows: high-resolution mode (tube voltage, 90.0 kV; tube current, 4.00 mA; rotation time, 16.8 s; field of view, 56 mm×56 mm; thickness, 0.099 mm). Histopathological characteristics were evaluated using histological slides of the surgical specimens. The Pearson chi-square test was used to compare ORN and MRONJ in terms of CBCT findings (internal texture, sequestrum, periosteal reaction and cortical perforation) and histopathological characteristics (necrotic bone, inflammatory cells, reactive bone formation, bacteria, Actinomyces, and osteoclasts). A P value less than 0.05 was considered to indicate statistical significance. Results: MRONJ showed periosteal reaction on CBCT more frequently than ORN (7 of 7 [100%] vs. 0 of 3 [0%], P<0.05). Regarding histopathological characteristics, MRONJ showed osteoclasts more frequently than ORN (6 of 7 [85.7%] vs. 0 of 3 [0%], P<0.05). Conclusion This study evaluated the CBCT imaging and histopathological characteristics of ORN and MRONJ, and the findings suggest that CBCT could be useful for the evaluation of ORN and MRONJ.