Objectives: This study aimed to investigate what third–year students of the J University School of Medicine had learned in home care practice.
Methods: We analyzed the students’ reports and focused on the description of the learning for the practice. We extracted the category of learning using qualitative content analysis.
Results and Conclusion: The core categories we extracted from the analyses were: 1） characteristics of home healthcare, 2） patients, 3） families, 4） home–visiting nurses, 5） medical treatment teams, 6） frank remarks of medical students and physicians, and 7） necessities as a physician. The frank remarks of medical students and physicians included the distrust of physicians and the hopes of medical students. The students gained valuable experience from this practice. In particular, learning about the distrust of physicians and the hopes of medical students may be difficult without such practice.

Background: Some early clinical exposure programs in the community have been implemented in our medical school from years 1 to 3: community service for the handicapped in year 1, care for severely handicapped children in year 2, and health care at home with district nurses in year 3. The directors of these programs informed us, in feedback reports, of the inappropriate behavior of medical students. We then provided feedback directly to the students. We investigated the changes in student behavior after feedback during the 3 years they participated in these programs.
Methods: We analyzed the feedback reports from these 3 early clinical exposure programs from 2009 to 2011. Inappropriate behavior of medical students and changes in behavior were recorded.
Results: Inappropriate behaviors reported were: 1） lack of essential learning behavior, 2） lack of positive attitude and acceptance of learning in the programs, and 3） lack of communication skills. The numbers of students who received feedback about inappropriate behaviors were 26 in year 1, 11 in year 2, and 2 in year 3. Feedback to students from early clinical exposure programs may lead to changes in their behavior.

The purpose of this study was to evaluate the function of cardiac autonomic nervous activity and post-exercise vagal reaction during the menstrual cycle. The subjects were healthy young women (n=13, age 19.9±0.6 years) with normal menstrual cycles. Power spectral analysis of heart rate variability was used to examine cardiac autonomic nervous activity. In addition, the time con stant of heart rate decline for the first 30 sec (T₃₀) after exercise was used to examine post-exercise vagal reactivation.
Results show that the cardiac autonomic nervous activity changes during the menstrual cycle. Also, T₃₀ shows significant change during the menstrual cycle, especially T₃₀ retardation in the early luteal phase. These results suggest that an imbalance of estradiol and progesterone hormones may be responsible for these changes in cardiac autonomic nervous activity during the menstrual cycle.

[Objective] The aim of this investigation was to evaluate serum steroid hormone responses to acute resistance exercise. [Methods] Subjects were young healthy males (n=6) and females (n=6) . Each group performed three sets of 10 leg press and 10 bench press exercises at an intensity of their individual 10-repetition maximum (1ORM), with 1 min rest between sets. Blood samples were collected before (Pre-Ex) and immediately following the exercise (P0), 30 mm (P30), 60 mm (P60), and 24 hours (P24h) after the exercise. Levels of blood lactate, serum testosterone, dehydroepian drosterone sulfate (DHEAS) and cortisol were determined. [Results] The levels of blood lactate in males and females significantly increased at P0 and P30 compared with Pre-Ex (p<0.05) . In males, the serum level of testosterone significantly increased at PO (p<0.05), whereas in females, it significantly decreased at P0, P30, P60, P 24 h. (p<0.05) . The level of DHEAS significantly increased at P0 in both males and females (p<0.05) . [Conclusion] The change in the level of testosterone was different between males and females, but that of DHEAS showed a similar pattern for both sexes. The data suggest that DHEAS could be a useful indicator for evaluating the anabolic status of acute resistance exercise in females.

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’.

Increased carotid arterial stiffness is associated with a risk factor of congestive heart failure. Thus factors that affect carotid arterial stiffness are of both physiological and clinical interest. The purpose of the present study was to examine the effects of regular aerobic exercise and menstrual cycle on carotid arterial stiffness in young female. The carotid β-stiffness index, an index of carotid arterial stiffness, was assessed in eight young female athletes (20.5 ± 0.4 years) and ten young female control subjects (21.3 ± 0.7 years). The carotid β-stiffness index was determined using ultrasound images of the common carotid artery with simultaneous recording of carotid arterial blood pressure by applanation tonometry. There was no difference in carotid β-stiffness index between the control and the athlete group both at the early follicular and the pre-ovulation phase of the menstrual cycle. On the other hand, the carotid β-stiffness index decreased from the early follicular phase to the pre-ovulation phase both in the control and the athlete group. These results suggest that carotid arterial stiffness in young females is not affected by regular aerobic exercise, but changes with the menstrual cycle, irrespective of exercise status.

This study was conducted to shed light on the actual conditions of home care and quality-of-life factors related to the burdens on families. For this purpose, a survey was carried out on main caretakers in the families who were using our home care support service. Fundamental information about the main caretakers and those who need care were garnered. In addition, WHO/QOL-26 and burdens for main caretakers were checked up on.The survey found that those who have looked after the sick or invalid for less than six months and those over five years keenly felt that they were shouldering a heavy burden. With the progression of dementia, the caretakers increasingly felt the burden getting heavier. Physical factors in QOL were linked to the burden which caretakers feel has to be borne, but psychological and social factors were not. This finding might have been ascribed to the fact that the persons surveyed were residents of the provincial city, part of which is rural. They were mostly old women and must have gained the support of their relatives. It is easy to assume that their role perception and sense of responsibility together with regional characteristics were reflected in psychological and social QOL factors.
Home care aspects ; SOCIAL ; Related ; Home care of patient ; Family Members

Objective: Substantial research has revealed cognitive function impairments in patients with major depressive disorder (MDD). However, the relationship between MDD cognitive function impairment and brain activity is yet to be elucidated. This study aimed to reveal this relationship using near-infrared spectroscopy (NIRS) to extensively measure frontotemporal cortex function. Methods: We recruited 18 inpatients with MDD and 22 healthy controls. Regional oxygenated hemoglobin changes (oxy-Hb) were measured during a verbal fluency task and its relationship to cognitive function was assessed. Cognitive function was assessed using the Japanese version of the Brief Assessment of Cognition in Schizophrenia. Results: Compared to healthy controls, patients with MDD displayed poorer motor speed, attention and speed of information processing, and executive function. In the bilateral prefrontal and temporal surface regions, regional oxy-Hb changes were significantly lower in patients with MDD than in healthy individuals. Moreover, we observed a correlation between reduced activation in the left temporal region and poor motor speed in patients with MDD. Conclusion We suggest that reduced activation in the left temporal region in patients with MDD could be a biomarker of poor motor speed. Additionally, NIRS may be useful as a noninvasive, clinical measurement tool for assessing motor speed in these patients.

Recently, the palliative care team (PCT) at our hospital has included dentists. Among a total of 127 cancer patientsand required PCT intervention from 2009 to 2014, 17 patients (13.3%) had oral symptoms. Therefore, the PCT held discussions in order to determine the optimal way to treat each patient. Various symptoms, including oral pain, dry mouth, taste disturbance, furred tongue, excessive amounts of saliva, appetite loss, and trismus were treated by the dentists. As a result, the oral findings improved in all patients, while the oral symptoms improved in 16 of the 17 patients (94%). Thanks to the fact that dentists have joined the PCT, oral symptoms are effectively relieved, and PCT members now have an increased interest in oral cavity complications. Furthermore, conducting thorough examinations of the oral cavity by the PCT not only results in an improved QOL, but it has also increased the interest in the oral cavity on the part of the PCT. Therefore, more effective palliative care is expected to be achieved by promoting increased cooperation with more clinical departments.

INTRODUCTIONCandidaemia, recognised as a fairly common disease among intensive care unit (ICU) patients, carries a poor prognosis. However, as studies on the prognostic factors associated with candidaemia in ICU patients are limited, this study aimed to establish the best prognostic factor for ICU patients with candidaemia in a tertiary care hospital in Japan.

METHODSWe conducted a retrospective cohort study of patients with candidaemia in the emergency ICU at Fukuoka University Hospital, Fukuoka, Japan, from April 2010 to March 2015. Demographic and clinical data was collected from the patients' medical records and laboratory databases.

RESULTSA total of 25 patients were included in the study. However, 18 patients died during hospitalisation, resulting in an in-hospital mortality rate of 72.0%. The variables of Sequential Organ Failure Assessment (SOFA) score and cumulative number of risk factors for invasive candidiasis showed significant differences between patients in the survivor and non-survivor groups (p < 0.05). The areas under the receiver operating characteristic curves for the SOFA score and cumulative number of risk factors for invasive candidiasis were 0.873 (95% confidence interval [CI] 0.72-1.00) and 0.937 (95% CI 0.84-1.00), respectively.

CONCLUSIONOur results suggest that the cumulative number of risk factors for invasive candidiasis was the most useful prognostic indicator for candidaemia in ICU patients.