To evaluate training methods for basic clinical skills before bedside learning, we used questionnaires to ask students and instructors their opinions about the fixed-instructor system, in which one instructor teaches the entire course, and the rotation system, in which instructors share responsibilities for teaching according to their specialty. Students had positive impressions of training with both systems. Many students felt that communication with in structors was good inthe fixed-instructor system and that the specialized education provided by multiple instructors was good in the rotation system. However, students expressed dissatisfaction about differences in educational content between the systems. Instructors believed an advantage of the fixed-instructor system was that skills learned could be applied to all medical fields, whereas the rotation system made teaching easier because it was specialized. On the basis of this investigation, we conclude that training should establish good communication between instructors and students and should include the required educational contents. We also found that unifying educational contents is difficult, regardless of the training system. Few reports about educational methods used to teach basic clinical skills have been published in Japan, but studies focusing on this issue are becoming increasingly necessary.

BACKGROUND: In general practice, though patients often stop visiting ambulatory clinics of their own vo-lition despite the need for ongoing medical treatment, there is little reported research on the reasons for nonattendance in Japan. In this study, we investigated whether the patient/doctor relationship influences nonattendance rates in general practice. In addition, we investigated the reasons why patients stopped visiting the hospital.
METHODS: We collected data from 115 patients (58 males, 57 females; age range: 16 to 94 years old, median age: 52 years old) whose initial diagnoses were made in our department from June to July 2000. We classified the patients into five groups based on the level of their complaints concerning the initial consultation (‘A’ representing the highest degree of complaint, ‘E’ representing the lowest) and determined the relationship between the strength of complaints and the non-attendance rate. Furthermore, we investigated the reasons for non-attendance concerning 28 patients who stopped visiting the hospital from April 2000 to November 2001.
RESULTS: The non-attendance rates were 0% (014) for group A, 14.3% (2114) for group B, 5.6% (5189) for group C, 33.3% (216) for group D, and 50% (1/2) for group E. The rate tended to be higher in groups with fewer complaints. The reasons for non-attendance were the following: remission of symptoms (9 patients), request for another hospital or department (6 patients), relief due to consultation at the university hospital (6 patients), and lack of time to come to the particular hospital (5 patients) . In contrast, the most common reason for satisfaction at the time of consultation was ‘enough explanation and listening to complaints well’ in 7 of 11 patients who were satisfied with the consultation.
CONCLUSIONS: The level of patient's complaints at the time of consultation is related to the non-attendance rate. However, sufficient explanation about symptoms and careful listening to complaints are important for establishing a good patient/doctor relationship.

This paper discussed the introductory medical training system and medical team care problems at University Hospital of Tsukuba.
The characteristics of this training system are that the duration of training is the fourth year medical students at the University of Tsukuba and to exercise the roles of nursing service at University Hospital.
In this practice, medical students are expected to comprehend about the significance of team work in medical care, to practice in the work of nurses and c-medical workers for learning their roles. We introduce our purpose and practice of this medical team care. Problems of this trial are discussed in this paper. But we have confirmed that this experimental. Trial is useful experience to all medical students and the items of this practical exercise are one of the most effective training method for them.

For the purpose of learning the comprehensive medical team care. we tried for the fourth year medical students at University of Tsukuba to exercise the nursing service and the team care system in the Hospital of University of Tsukuba.
These practice were already undergone during past twelve years.
In this practice, students are expected to comprehend about the significance of team work in medical care, to understand the meaning of medical care, to learn especially the roles of nursing and rehabilitation medicine (in total medical care system), to practice in the work of nurses and co-medical workers for understanding their roles, to study the basic science and contribution in medical team care of rehabilitation medicine, to comprehend about the outline of the health, medical care system, and medical economics.
As the items of this practical exercise, all students must work as follows:
1. collection of venous blood and check of vital signs.
2. practical work of nursing service.
day time service: 8:00 a.m.-11:30 a.m.(fourtimes)
1:00 p.m.-4:30 p.m.(once)
early night service: 5:00 p.m.-0:00 a.m.(once)
midnight service: 0:00 a.m.-8:30 a.m.(once)
Moreover 15 corelative lectures are prepared.
For these twelve years, we researched motivating effects and impression of this exercise about both medical students and nurses by method of using questionnaire. We hope to grow kindly doctors having the mind of humanity.

1) We investigated the patients'evaluations of the students, our management of the medical training, and the patients' recognition of our outpatient clinic education. We then requested the patients to give their opinions regarding such interviews.
2) The patients'evaluations of the outpatient clinic and the patients'recognition of our outpatient clinic education were relatively good, but some patients complained about the short duration of medical care and also expressed anxiety over the students'medical interview.
3) Many patients expressed the desire to positively participate in medical education because the patients had high expectations of the medical students.In addition, this interview training fulfilled the patients'desire to be listened to and have their concerns acknowledged.

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

　　Catamenial pneumothorax (CP) is defined as a form of thoracic endometriosis syndrome (TES) and the clinical manifestations and management of this disease are not consensual. Successful treatment depends on how closely pulmonary specialists and gynecologists work together. Such being the circumstances, we reviewed our experience with CP in terms of treatment and follow-up. We treated surgically many patients with pneumothorax during the period from 1989 to 2014, of which eight cases had endometriosis on the diaphragm, lung or pleura histologically. The median age at the time of operation was 37 (range, 17 to 41). CP was right-sided in seven of the eight patients (87.5%). Six patients underwent an examination with diagnostic laparoscopy and five had positive findings. The median period of follow-up after surgery was 33.5 months (range, 4 to 129 months). Two patients had no recurrence without hormonal therapy. Six other patients experienced a recurrence of pneumothorax, although two patients received dienogest after surgery. The use of only dienogest or both GnRHa and dienogest prevented recurrence in all patients. CP is a critical condition that requires prompt action, so after surgical treatment, the choice of hormonal therapy with a high rate of patient compliance are needed. No recurrence occurred in young patients who had only surgical treatment, suggesting that there were some associations between age and recurrence. Since we succeeded in preventing recurrence after using GnRHa in all cases, we recommend GnRHa or dienogest following GnRHa for the first choice of hormonal therapy after surgery. However, treatment with only dienogest could achieve successful results with no recurrence, so more case studies need to be done to make the best treatment choice for each case.

　　Adhesion formation after abdominal surgery is a commonly recognized entity. Many studies have shown that women giving birth by cesarean section are at the risk of developing complications related to the postoperative formation of adhesions including ileus, bowel obstructions, impaired fertility, and chronic abdominal pain. Among several adhesion barriers, one that has been tested in randomized, controlled trials is the hyaluronic cid-carboxymethylcellulose (HA/CMC) membrane (Seprafilm®: Genzyme, Cambridge, MA, USA). This bioresorbable membrane serves as a mechanical barrier between surgically damaged tissues and resorbs afterwards. At our institution, we have used HA/CMC in cesarean sections. We report our experience with this patient population using placement of HA/CMC.　　This study enrolled 45 women who had undergone cesarean sections twice or more who had received HA/CMC during the previous cesarean section between January 2013 and November 2014. The incidence of adhesions to the area of abdominal wall incisions and uterine surface, intestinal obstructive symptoms, and adverse events were studied. The incidence of adhesions to midline incisions was 4.4% (n＝2). The filmy adhesion by major omentum was detected in these two cases. The incidence of adhesions to uterine surface was 2.2% (n＝1). The moderate thickness adhesion was detected at the left side of the vesico-uterine peritoneal incision by pelvic peritoneum which did not affect the operative procedure. No symptoms related to intestinal obstructions such as abdominal pains, nausea and vomiting were observed. No adverse events were observed. These three cases had fever which had nothing to do with HA/CMC applications but was attributable respectively to influenza infection, mastitis, phlebitis associated with a needle procedure.　　HA/CMC was considered a useful adhesion barrier membrane for use in cesarean sections as an adjunct intended to reduce the incidence of postoperative adhesions between the abdominal wall and the underlying viscera such as omentum, small bowel, and between the uterus and surrounding structures.

　　We have developed a new surgical procedure for uterine prolapse of round ligament suspension to the psoas minor tendon by the use of a laparoscope. Here, we describe the new technique and report the outcome of surgery in three cases.　　Operative procedure: The fundus of the uterus is lifted back up to its natural position by fixing the round ligament of the uterus to the psoas minor tendon after incising the peritoneum covering psoas. It is important to use the tendon as a stronger reattachment site in addition to the psoas major muscle. The round ligament is tacked to the tendon by a 2-0 nonabsorbable suture on bilateral sides. The second suture may be added if the uterus is not appropriately lifted up by the first suture. The retroperioneum is closed by a continuous 3-0 absorbable suture after fixation.　　Cases: Two patients with severe uterine prolapse and one patient with a mild condition went through the operation safely and have experienced no recurrence for 10 to 24 months. One severely ill patient complained about post -operative right inguinal pain early and another with the severe condition complained that something felt wrong with the right thigh.　　We propose the operation of laparoscopic round ligament psoas minor tendon-hitching as a safe and effective surgical treatment for uterine prolapse.

　　A 59-year-old woman, para 2, attended our hospital for an abdominal mass and atypical genital bleeding. Magnetic resonance imaging revealed a 30×25cm uterine myoma. A preoperative blood examination showed the following results: hemoglobin, 21g/dl; hematocrit, 71.5%; erythropoietin, 38.5mIU/ml; and estradiol, 29.9pg/ml. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed, with an estimated blood loss of 1650ml. The weight of the uterus, including the myoma nodule, was 4740g, and the results of histology confirmed the diagnosis of leiomyoma. By postoperative day 28, her hemoglobin, erythropoietin, and estradiol levels had fallen to levels of 15.1g/dl, 6.0mIU/ml, and 5.8pg/ml, respectively, which are normal for a postmenopausal woman. The findings suggest that the leiomyoma secreted erythropoietin and induced erythrocytosis. Estradiol stimulates erythropoietin secretion and enlargement of the leiomyoma. Some studies have shown that erythropoietin is also a growth factor for leiomyoma. More than half of the erythropoietin-producing leiomyomas are detected after menopause. It was discovered that leiomyoma cells can produce aromatase, which transforms androstenedione into estradiol. Although estradiol secretion from the ovaries decreases in the postmenopausal period, the estradiol and erythropoietin autocrine/paracrine system in leiomyoma might promote its own growth after menopause.