Background: Few medical education programs provide hands-on classes using electronic medical charts for a large number of students.
Methods: To simulate a medical interview, third- and sixth-year medical students viewed electronic medical chart samples on a screen, created by FileMaker, and discussed patient management. Following this, they underwent a questionnaire survey.
Results: A total of 63.1 and 76.3% of the third- and sixth-year students responded to the questionnaire, and 87.1 and 78.9% of the responders became interested in the class, respectively, because it focused on hands-on, practical training. A total of 5.6% of third-year students stated that the class was difficult to master but they hoped to continue learning.
Discussion: The adoption of a hands-on class using electronic medical charts interested even junior medical students.

 Since the 1960s, Japanese nurses have been working as international nursing collaborators with or for the people in developing countries in order to promote health through transferring nursing knowledge and skill. However a number of nurses reported that they did not have enough competencies as international nursing collaborators. The objectives of this study were: a) to describe the experiences of Japanese international nursing collaborators whose mission was transferring nursing knowledge and skill and b) to determine their learning needs as international collaborators, and to design educational programs (graduate program) based on the results of survey. The participants of this study were twenty-seven nurses who had had an international collaborative mission and stayed in a developing country for more than one year. Semi-structured group or individual interviews were used in order to describe activities process and leaning needs as international collaborators. The interview data were analyzed using content analysis from the viewpoint of competency and learning needs. Nurses reported needs in two major areas: Fundamental Competences and Knowledge, and Required Competences for Development of International Collaborative Tasks. Fundamental Competences and Knowledge consisted of nine components: (1) cross-cultural experiences, (2) acceptance of cultural differences, (3) professional experience, (4) degree and qualifications, (5) philosophy of nursing, (6) language, (7) interdisciplinary knowledge for international cooperation activities, (8) knowledge about own project, and (9) knowledge on theories of international cooperation. Required Competences for Development of International Collaborative Tasks consisted of thirty components which were divided into four phases (personal competences, preparation and planning phase, implementation phase, and after project.) Based on the result of this survey the investigators designed the international nursing graduate program. The program has started from the academic year of 2005 at the investigators' college. The progress of students' learning and outcomes of these educational programs should be monitored using formative evaluation.

The Medication Guides for Patients (MGPs) are being offered as information on prescription drugs for patients by the Ministry of Health, Labour and Welfare (MHLW). The MHLW published the Risk Management Plan in April, 2012, and it noted that the MGPs should be utilized in usual risk minimization activities. It is not clear, however, whether the MGPs are efficiently utilized in actual settings. Hence, we conducted a questionnaire survey of the pharmacists in the pharmacies with dispensing and the hospitals in Mie and Yamagata prefectures to investigate the actual circumstances of MGPs utilization and to understand the existing barriers associated with the use of the MGPs as medication instructions for patients. We sent the questionnaires by mail and obtained responses from 444 facilities (33.9%) of 1,309 facilities. The recognition level of the MGPs was about 30 percent in the dispensing pharmacies, and about 50 percent in the hospitals. The MGPs were utilized as a common communication tool with the patients in approximately 20 percent of the facilities. Many respondents requested that the frequency of important and other adverse reactions should be described in the MGPs, and wider ranges of MGPs should be further implemented.
Moreover, our data suggests the problem is that the present MGPs are mainly applied to special types of patients, such as those with higher literacy level or those who requested a detailed explanation. Thus, it is apparent that it is necessary to review the MGPs contents again to improve their practical benefits and disseminate them more widely.

Introduction: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. State: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. Problem: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

OBJECTIVEThe aim of this study was to establish reference concentrations of urinary strontium by inductively coupled plasma atomic emission spectrometry (ICP-AES).

METHODSFor the determination of strontium, urine samples were collected from healthy Japanese (n=146; 115 males, 31 females; mean age, 33±9 years; age range, 18 to 58 years). The urine samples stored at or below -20°C were thawed with incubation at 40°C for 30 min and sediments were dissolved by vigorous shakings. Then, the samples were centrifuged at 3000 g for 5 min, and the supernatant was directly aspired into a P-5200-3600/1200 ICP-AES system from Hitachi Ltd., Tokyo, Japan.

RESULTSA steeper increase in the S/N ratio and a good effective linearity of the calibration line was obtained at 407.771 nm in the range of 0-300 μg/L strontium standard solution. Urine samples having the same background signal as that of 18 MΩ cm ultrapure blank water, a good correspondence of the single peak pattern of the spectra, accuracy and precision of spike recovery were also confirmed. Urinary strontium concentrations showed a log-normal distribution and a geometric mean concentration of 143.9 μg/L, with 5-95% confidential interval of 40.9-505.8 μg/L.

CONCLUSIONThe results of this study will be useful as guidelines for the biological monitoring of strontium in normal subjects and in individuals therapeutically or environmentally exposed to strontium.