1.Medical education program in Malaysia
Medical Education 2009;40(5):311-316
1) We report on medical education programs in Malaysia on the basis of investigations of 2 national universities and 1 private medical college.2) Although the history of medical education in Malaysia is short, the education programs are efficient and conform to global standards.
2.A questionnaire survey concerning the distribution and equipment of clinical skills laboratories in Japanese medical schools: Simulation-based skills training courses in clinical skills laboratories
Toshiya SUZUKI ; Masashi BEPPU ; Nobuo NARA
Medical Education 2009;40(5):361-365
1) Simulation-based training is critical for medical students to acquire clinical skills. We sent questionnaires to all 80 medical schools in Japan asking about the status of clinical skills laboratories and received responses from 73 medical schools.2) Fifty-nine schools have skills laboratories. Forty-nine schools have curricula integrating simulation-based skills training. The 3 most common apparatuses are venopuncture trainers, basic life support mannequins, and skin-suturing trainers. Lung and heart sound auscultation trainers, advanced cardiac life support mannequins, and ophthalmoscopy trainers are used at more than 50 schools.3) Thirty-two of the 59 schools have simulation-based skills-training courses that are not included in the undergraduate medical curriculum. Medical staff and people in the community are participating. The four most common courses are, in descending order, basic life support, intermediate cardiac life support, advanced cardiac life support, and automated external defibrillation, which are held at more than 16 schools.
3.Medical Education in Korea
Toshiya SUZUKI ; Masashi BEPPU ; Keiichi YOSHIHARA ; Nobuo NARA
Medical Education 2009;40(5):322-325
The medical school system of Korea was patterned after the system used in the United States. Objective structured clinical examination/complete physical examination will be introduced to the national medical board examination in 2009.Medical educators insist on the importance of clinical clerkships and have introduced simulation-based learning in new curricula.We report on whether this new system is working well or not for possible use in the reform of medical education in Japan.
4.Assessment of training in cardiac auscultation using a simulator
Masashi BEPPU ; Nobuo NARA ; Toshiya SUZUKI ; Mitsuaki ISOBE
Medical Education 2009;40(6):419-424
The use of simulators for skills training has become widespread. However, no quantitative analysis has been performed to determine whether simulation-based medical education is useful for improving the acquisition of clinical skills. The educational effect must be evaluated to further develop stimulation-based education. A seminar for cardiac auscultation was held, with the skills laboratory taking the initiative; the effectiveness was verified, and various problems were identified.1)The skills laboratory held a series of training seminars to examine the effectiveness of simulation-based education.2) Sixteen medical students participated in the seminars. One seminar lasted 120 minutes, including 60 minutes of lectures and 60 minutes of skills training. All students attended the three seminars. A questionnaire survey, a written examination, and a skills test were administered to all students three times (before, immediately after, and 5 months after the seminars).3) The students were extremely satisfied with the seminars. The students believed their cardiac auscultation skills had improved and that this improvement was still present 5 months later. After the seminars, the heart sound simulators were used more frequently than before the seminar.4) The results of skills testing after the seminars were better than those before the seminars and remained better 5 months later. However, results of a written examination 5 months after the seminars were similar to those before the seminars.5) The seminars in the skills laboratory were effective for improving students' auscultation skills and increased the effective use of mannequins in the skills laboratory.
5.Development of a Quick High-Yield Method for the Preparation of Decoctions, Inspired by the “Zhu san Fa” of the Song Period (Part 2)
Tsukasa FUEKI ; Toshiaki MAKINO ; Takanori MATSUOKA ; Masashi BEPPU ; Takao SUNAGA ; Koichiro TANAKA ; Takao NAMIKI
Kampo Medicine 2016;67(2):114-122
The IPCD (Immersing Powdered Crude Drugs) method, inspired by the “zhu san fa” which was widely used in the Song period of China, has been developed to prepare Kampo decoctions quickly and easily, with highyield extract from crude drugs. One trouble with the IPCD method occurs when separating the decoction from the muddy residue of the crude drug powder. When powdered ephedra herb is packed in a nonwoven fabric bag and immersed in hot water, yield of the marker compounds is much lower than that obtained when ephedra herb powder is dispersed freely in hot water without a nonwoven fabric bag. Thus the use of a nonwoven fabric bag was shown to be unsuitable with the IPCD method. In investigating an easy and more efficient separation method, we tried decanting with a commercially available wine carafe to separate the decoction and residue. With IPCD followed by decantation using the wine carafe, yields of about 80% decoction volume were obtained as compared with those when cut crude drugs are decocted and filtered using a tea strainer, in 6 of the 7 formulas tried. We find that decantation using a wine carafe is a more practical way of separation in the IPCD method.
6.Differences in Water Hardness when preparing Ephedrae Herba Decoctions : Special Focus on a Comparison of Tap Water in Japan and China
Tsukasa FUEKI ; Takanori MATSUOKA ; Masashi BEPPU ; Hidetoshi YAMAGUCHI ; Hideyuki NAKATA ; Kenshu RAI ; Yumi SAKAI ; Kazuhiko NAGASAKA ; Toshiaki MAKINO ; Takao NAMIKI ; Kenkichi OKADA ; Yusen IWAI ; Kazuhiro MAKIZUMI
Kampo Medicine 2012;63(5):313-321
Decoctions of Ephedrae Herba were prepared using tap water sampled in Changping District, Beijing City(China), tap water sampled in Niigata City (Japan) and some mineral water samples sold in markets. Various dissimilarities were found between drug extracts prepared using tap water in Japan and China, and the extraction efficiency of the alkaloids with Beijing tap water was approximately 80% of that with Niigata tap water. It is suggested that these dissimilarities result from concentrations of temporally hard components, such as calcium and magnesium bicarbonate salts, in the water. In addition, when Zizyphi Fructus and Ephedrae Herba were decocted together in hard water, the state of the decoction, ephedra-alkaloid content included, was found to come close to that of single Ephedrae Herba decoctions prepared using soft water. It was suggested that Ziziphi Fructus might possibly play roles as a softening agent in decoctions prepared using hard water.
7.On Ryokyu ARIMA, Tenmin NAMIKAWA's Mentor
Takanori MATSUOKA ; Hideki KURIBAYASHI ; Masashi BEPPU ; Hidetoshi YAMAGUCHI ; Hideyuki NAKATA ; Tamie ANAN ; Tsukasa FUEKI ; Kenju RAI ; Hidetoshi ITAKURA ; Koichiro TANAKA ; Yoshinari KONO ; Mikumo UEMATSU ; Kazuhiko NARA ; Keiko SERIZAWA ; Kenkichi OKADA ; Yusen IWAI ; Kazuhiro MAKIZUMI ; Oto MIURA ; Takao NAMIKI ; Tetsuo AKIBA
Kampo Medicine 2012;63(6):417-427
Tenmin NAMIKAWA (並河天民) thought the Shanghanlun (傷寒論) was an important text. He also taught his pupils the importance of prescribing Zhongjing ZHANG's (張仲景) medicines. Ryokyu ARIMA (有馬凉及) was a physician-teacher, who prescribed Chengqitang (承気湯) for the emperor without conferring with other doctors. His chengqitang formulary was derived from medical texts by Zhongjing ZHANG. Kyugo GODA (合田求吾) on the other hand, was a pupil of Ikkannsai MATSUBARA (松原一閑斎), who wrote in the Idokikigaki (医道聞書) : theKoho (古方) school started by Ryokyu ARIMA. He was a hero who was punished by the Goseiin (後西院) emperor. He taught Koho to Tenmin. This therefore reveals that Ryokyu ARIMA was a teacher who taught the importance of the Shanghanlun.
8.The Weights in Ben Cao Jing Ji Zhu (Dun Huang Version) and the Volume of a Fang Cun Bi (One Cun Square Spoon) : Weights and Measures in the Period when the Shan Han Lun was Written
Tsukasa FUEKI ; Takanori MATSUOKA ; Toshiaki MAKINO ; Takao NAMIKI ; Masashi BEPPU ; Hidetoshi YAMAGUCHI ; Hideyuki NAKATA ; Kenshu RAI ; Keisuke HAGIHARA ; Koichiro TANAKA ; Kazuhiko NAGASAKA ; Takao SUNAGA ; I-JUNG LEE ; Kenkichi OKADA ; Yusen IWAI ; Kazuhiro MAKIZUMI
Kampo Medicine 2014;65(1):38-45
For the purpose of investigating weights in the era when the Shan Han Lun was set forth, the weight and measures described in the Ben Cao Jing Ji Zhu, written in the period slightly after the Shan Han Lun, were studied. Some descriptions of the metrological standards are confusing in the Ben Cao Jing Ji Zhu. We focused on the measuring container, whose volume is equal to that of the one cun square spoon (fang cun bi), shown in the dun huang version of the Ben Cao Jing Ji Zhu. The volume of this measuring container was calculated on the assumption that the measures in this text follow those of the Han Shu Li Li Shi, and a result of 5.07 cm3 was obtained. The result was confirmed by using the actual measured values of the crude drugs. The result was also considered to support measurements of the volume in the Ben Cao Jing Ji Zhu as following the Han Shu Li Li Shi. With those results, descriptions of the density of honey and lard were examined, and the weight in the Ben Cao Jing Ji Zhu was clarified to follow that in the Han Shu Li Li Shi.
9.The Investigation of Metrological Standard in “Songban Shanghanlun” :Focus on the Absorbed Liquid in the Decoction Residues and the Extraction Efficiency of Ephedra-alkal
Tsukasa FUEKI ; Takanori MATSUOKA ; Toshiaki MAKINO ; Takao NAMIKI ; Masashi BEPPU ; Hidetoshi YAMAGUCHI ; Hideyuki NAKATA ; Kenshu RAI ; Keisuke HAGIHARA ; Koichiro TANAKA ; Takao SUNAGA ; Kazuhiko NAGASAKA ; Kenkichi OKADA ; Yusen IWAI ; Kazuhiro MAKIZUMI
Kampo Medicine 2014;65(2):61-72
The dosage of crude drugs described in the Shanghanlun has long been discussed, and a conversion ratio for 1 liang in the Songban Shanghanlun into modern grams has not been established yet. Ekisai Kariya, a bibliologist in Edo period Japan, claimed that the formulas in the Songban Shanghanlun could not be decocted when weighed with the “Han shu (lu li zhi)” scale (1 liang = 14 g, “regular scale”), and the weight scale in the text should be “Scale of Shen nong” (1/10 scale of the regular scale). This claim leads to the standards for Kampo prescription dosages. We inspected this matter by focusing on the amount of liquid absorbed by decoction residues, and demonstrated that the formulas in Songban Shanghanlun could actually be decocted when weighed with the “regular scale”. In addition, we calculated the quantities of Ephedra-alkaloids in the one-time dose of “Ma huang tang” of the several books written in the Song period, and the Songban Shanghanlun text, with results showing that Chinese doctors in the Song period recognized 1 liang in the Songban Shanghanlun as 14 grams in modern terms, and that the “regular scale” could be applied clinically. This strongly suggests that the metrological standard in the Songban Shanghanlun should be the “regular scale”.
10.The Decocting Time and the Contents of the Aconitine-type Diester Alkaloids in the Decoctions of the Formula Containing Unprocessed Aconite Root in “Songban Shanghanlun”
Tsukasa FUEKI ; Yohei TANIMURA ; Koichiro TANAKA ; Koki CHIBA ; Takanori MATSUOKA ; Takao NAMIKI ; Kosuke FUJITA ; Takao SUNAGA ; Masashi BEPPU ; Toshiaki MAKINO
Kampo Medicine 2019;70(4):313-323
We investigated the decocting time to prepare the formulas containing unprocessed aconite root, such as shigyakuto, tsumyaku shigyakuto, and kankyobushito, which had been registered in “Shanghanlun” edited in Song Dynasty, using the weights and measures in Houhan Dynasty when the original “Shanghanlun” was regarded to have been established. Also the contents of aconitine-type diester alkaloids (ADA) eluted from unprocessed aconite root in the decoction were analyzed in time-dependent manners. As regards the modified formula for the “physically strong patients” in the texts of tsumyakushigyakuto in “Shanghanlun”, adding dried ginger was found to lead the decocting time to be shorter and the sum of ADA content in the decoction of the modified formula to increase about 20%. It was also found that the compositions of diterpene alkaloids derived from aconite root in kankyobushito decoction were highly different from those in shigyakuto decoction, containing less ADA and more aconine and hypaconine, due to the high pH of the decoction, which was the consequence of lacking glycyrrhiza in kankyobushito formula. It is suggested that the doctors in the era of “Shanghanlun” establishment may have carefully adjusted the contents of ADA in the decoctions using unprocessed aconite root by choosing co-decocted crude drugs.
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