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.

We conducted a nationwide survey in 2000 regarding undergraduate medical education in Evidence-based Medicine (EBM) in Japan. We asked faculty members responsible for medical education at each medical school 1) whether there are any barriers to teaching EBM, 2) what these barriers are, and 3) what educational resources are needed to overcome them. Responses were received from 64 schools (80%). More than half of the respondents reported barriers to teaching EBM. We identified two kinds of barriers: before EBM is introduced, skepticism toward the concept of EBM and the value of teaching EBM is encountered; later, problems of organizing a curriculum and shortages of staff and materials are encountered. To overcome these barriers, we need: 1) to establish organizations for coordinating educational programs among medical schools, 2) to hold seminars for faculty development, 3) to develop EBM curricula and teaching materials, and 4) to provide computer facilities and appropriate networks.

Objective: The present study examined the status of the provision of drug information to hypertensive patients at community-based pharmacies by evaluating patients' satisfaction, understanding, and wishes.
Design: A cross-sectional study was conducted by surveying patients using a self-administered questionnaire.
Methods: Three items were evaluated: 1) the level of patient satisfaction with provision of drug information; 2) the level of patient understanding of information provided on antihypertensive drugs; and, 3) patient wishes regarding provision of drug information.
Results: The level of satisfaction with provision of drug information was high (86.6%). Although patients were found to understand the precautions for use of antihypertensive drugs, their understanding of drug efficacy was insufficient. Also, patients wished to receive more explanation from pharmacists regarding the efficacy of drugs in addition to explanations of associated adverse reactions or precautions for use of the drugs.
Conclusions: Hypertensive patients were highly satisfied with the provision of drug information at community-based pharmacies, but did not show sufficient understanding of the efficacy of antihypertensive drugs, an issue to be addressed in the future by pharmacists in their instructions to patients on the use of drugs.

Objectives : Mediastinitis results in significant morbidity in pediatric patients after cardiac surgery. The management of mediastinitis is not well established in the pediatric population. Our strategy for pediatric mediastinitis after cardiac surgery consists of rapid introduction of simple vacuum-assisted drainage system and sternal closure without plombage under aseptic conditions. The efficacy of our strategy was examined. Methods : The records of 7 pediatric patients with mediastinitis after cardiac surgery managed with this drainage system from May 2006 to May 2013 were retrospectively reviewed. The median age of the patients was 20.5 months and median body weight was 9.7 kg. Mediastinitis occurred 1-3 weeks after surgery. The mediastinum was re-explored immediately under general anesthesia after the diagnosis was made, and continuous drainage was used after extensive debridement was performed. We developed a simple vacuum-assisted drainage system consisting of conventional polyurethane foam, surgical drape containing povidone-iodine, and 1 to 3 silicone drainage tubes connected to a drain aspirator (-99 cmH₂O). Patients were allowed oral intake and resumption of daily activity after extubation. The components of the drainage system were exchanged every 2-3 days. The sternum was closed without the use of the omentum or muscle for plombage of the mediastinum after two negative topical swab cultures were obtained. Results : Negative topical swab cultures were obtained in all cases (3-12 days after the drainage commencement) and the sternum was closed 7-19 days after the drainage commencement. The median duration of hospital stay was 31 days (range, 14-47). Although one patient with prenatal infection died of aortic rupture, the remaining six children survived and did not experience recurrence after hospital discharge. Conclusion : The simple vacuum-assisted drainage system enabled rapid control of wound bacterial infection and sternal closure in postoperative pediatric mediastinitis without the need for special, and expensive devices.

A clinical clerkship program was introduced at the University of Tokyo in 2002 to help students acquire clinical knowledge, skills, and attitudes by increasing their involvement in clinical activities. We assessed the learning effectiveness of clinical clerkships at the University of Tokyo Hospital by examining evaluations of student's clinical competence by themselves and by the faculty. Methods: We evaluated each clerkship with reference to overall educational goals developed in advance. We measured students' self-evaluations and evaluatio s by the faculty before and after the clerkship. Results: At the end of the 2-month clerkship, students' self-evaluation scores (3.18) were significantly higher than before the clerkship (2.71). In particular, scores for patient care were markedly higher. Evaluation scores by the faculty were also higher during (3.64) and after (3.57) clerkships than before (3.26) clerkships. Conclusion: We will use this data to make next year's clerkship programs more effective. We should also develop more-objective strategies for evaluation and establish relevant educational goals.

The purpose of this study was to evaluate the clinical clerkship program at the University of Tokyo Hospital. We report results of course and faculty evaluations by students and of qualitative evaluations, such as students, free comments and group interviews. Methods: Each item of the course and faculty evaluations was related to the overall educational goals developed in advance. Students evaluated the course and faculty immediately after the course ended. Results: Students rated the clerkship program favorably overall, but the scores of thesecond month (3.38) were lower that those of the first month (3.63). Although learning basic clinical procedures is not the main educational goal of the clerkship, students varied widely in their opportunities to perform procedures. Scores of faculty evaluations ranged from 2.93 to 3.87 in the first month and were lower in the second month for all but two items. Interviews revealed that students had fewer learning experiences in the second month because new residents started their rotations at that time. Conclusion: The results suggest that the scheduling of clinical clerkships should be changed. The contents of clerkship need further consideration.

A 48-year-old man underwent an non-anatomical bypass surgery for aortic coarctation when he was 38 years old, when a bypass laid between the left subclavian artery and the descending aorta with a prosthesis (10 mm, internal diameter). Four years after the first surgery, aortic aneurysms at the proximal and distal sites of the coarctation were detected. Six years from then, we decided to perform another surgery when the maximum diameters of the proximal and distal sites exceeded 60 and 47 mm, respectively. We performed the aortic replacement from the proximal left subclavian artery to the descending aorta at eighth thoracic vertebra. The approach to the aortic aneurysm was through the extended left thoracotomy with the transection of the sternum. The cardiopulmonary bypass was established with an antegrade aortic perfusion (from the ascending aorta) and drainage from the right atrium. The circulatory arrest was obtained under deep hypothermia at 20°C measured by deep body temperature. After the surgery, the pressure differences between upper and lower extremities decreased to 10 mmHg, which had been 40 mmHg before surgery. Macroscopic observation showed the coarctation site was completely obstructed by an old thrombus. From this observation, we surmise that one of the reasons for the aneurysmal formation at the proximal site of coarctation might be an insufficient depressurization by the non-anatomical bypass grafting from the left subclavian artery to the descending aorta at the first surgery. We consider that a severe coarctation might become thrombotic sooner or later after a non-anatomical bypass surgery due to a change of blood flow, and a radical anatomical surgery would be recommended for adult coarctation cases.

Purpose: Dental floss clip (DFC) traction-assisted endoscopic submucosal dissection (ESD) is widely performed owing to its simplicity. This study aimed to clarify the appropriate indications for the DFC traction method in early gastric cancer when ESD is performed by less-experienced endoscopists. Methods: and Methods: We retrospectively analyzed 1,014 consecutive patients who had undergone gastric ESD performed by less-experienced endoscopists between January 2015 and December 2020. Gastric ESD was performed without DFC in all cases before December 2017 [DFC (−) group, 376 cases], and ESD was performed with DFC in all cases after January 2018 [DFC (+) group, 436 cases]. The procedure time and rates of en bloc resection, complete resection, and adverse events of the groups were compared. Results: The procedure time did not differ significantly between the 2 groups. However, when comparing lesions >20 mm, the procedure time in the DFC (+) group was significantly shorter than that in the DFC (−) group (95±46 vs. 75±31, P<0.01). The procedure time for lesions located in the greater curvature of the upper or middle stomach and lesions >20 mm located in the lesser curvature side of the stomach in the DFC (+) group was significantly shorter than that in the DFC (−) group. Conclusions The indications for DFC during gastric ESD by less-experienced endoscopists include lesions located in the greater curvature of the upper or middle stomach, and lesions >20 mm located in the lesser curvature of the stomach.