To clarify the experience in clinical practice of students at Osaka University Medical School, a questionnaire survey was performed according to the International Classification of Primary Care. More than half of the students had observed only 6 of the 23 reasons for seeking primary care such as headache and hypertension but had not experienced 17 of the 23 reasons, such as cough and abdominal pain. Most students had observed malignancy and chronic diseases, but more than half had only knowledge of 54 of 105 diseases such as appendicitis. In conclusion, medical students' experiences in clinical practice are not well balanced.

Objective：The aim of this study was to examine the efficacy and safety of hochuekkito to address reduced activities of daily living (ADL), nutritional status, and immunity in patients with severe conditions, represented by a functional independence measure (FIM) total score of ≤ 40.

Methods：Thirty-one patients who were undergoing rehabilitation for hemiplegia after cerebrovascular disease were randomized into 2 groups：those treated with hochuekkito (TJ-41 group) and those treated without hochuekkito (control group). Their conditions were observed for 24 weeks, focusing on items such as ADL and incidence of inflammatory complications.

Results：The FIM total score markedly improved after treatment in both groups, but the changes in the score between admission and discharge were similar between the two groups. The incidence of inflammatory complications was significantly lower in the TJ-41 group (P = 0.049). Among the patients with a motor FIM score of ≤ 20, those in the TJ-41 group showed a tendency of increase in total lymphocyte count after treatment. No adverse drug reactions were observed during the study period.

Conclusion：These results suggest that hochuekkito is effective in reducing the incidence of inflammatory complications in patients undergoing rehabilitation for cerebrovascular or other diseases.

Purpose： In this study, we aimed to investigate the discrepancy between interview by medical personnel using 3‒point verbal rating scale (VRS) and patient complaints using numerical rating scale (NRS) in nausea diary for chemotherapy‒induced nausea. Patients and Method： In this study, we targeted patients who received chemotherapy at the gynecology department in our hospital and who recorded information in nausea diary. The discrepancy was estimated from NRS in nausea diary and the degree of nausea obtained by medical interview at approximately the same time period. We classified it into overvaluation, undervaluation or non‒discrepancy. Result： A total of 663 cases was analyzed, and 54 patientswere enrolled. The discrepancy was 25.2％ (undervaluation 5.4%; overvaluation 19.8％), and mostly overvaluation was observed. NRS in nausea diary had a significant correlation with the degree of nausea obtained by medical interview（P<0.001, r=0.66） , and the kappa statistic was 0.36. Conclusion： Ratio of non‒undervaluation is approximately 95%; hence, we conclude that interview by medical personnel using VRS accurately reflects the degree of nausea.

No abstract available.
Antitoxins/*therapeutic use ; Clostridium perfringens/*pathogenicity ; Hemolysis ; Humans ; Immunologic Factors/*therapeutic use ; Liver Abscess/*drug therapy/microbiology

The experience at the time of a patient’s death can affect the mental health of bereaved families. Performing death pronouncements is an important skill for end-of-life care. However, almost no educational content regarding death pronouncements is presently included in medical educational programs. We have created a guidebook for “Physician behavior at the time of death pronouncement” based on the results of a questionnaire given to the families of deceased patients that included several items related to this topic. The purpose of this research was to investigate the educational effect of using this guidebook. The guidebook was given to 4th-year medical students attending the Yokohama City University School of Medicine. A survey was then conducted to assess evaluations of self-practice and feelings of difficulty at the time of making death pronouncements both before and after the class. Among the 39 students who provided valid responses, the majority (89.5%) indicated that they had difficulty with the item regarding “the specific method of death pronouncement.” A significant improvement was observed between the responses obtained before and those obtained after the class. We concluded that our guidebook for physician behavior at the time of death pronouncement might be useful for the education of medical students.

Introduction: Tramadol (TRM) has been included as a weak opioid at the second step of the WHO analgesic ladder and has been widely used in palliative medicine. Here we report a case of amelioration of cancer pain by TRM therapy in a female patient with myasthenia gravis (MG). Case:The patient was a 70’s woman who was diagnosed with advanced endometrial carcinoma and suffered from chest pain caused by chest metastasis. 25 mg of a TRM capsule was orally administered three times a day. The dose was increased to 50 mg twice a day. It was resulted in sound pain relief with transient muscle weakness but without a myasthenic crisis.

OBJECTIVE: To analyze patient characteristics of cancer rehabilitation and outcomes at our hospital. METHODS: This retrospective study analyzed 580 patients, who underwent cancer rehabilitation at our hospital and rehabilitation outcome after therapy were investigated. The relationship between the initial Barthel index and discharge outcomes was investigated, with a special focus on cancer patients with bone metastasis. The Barthel index and performance status (Eastern Cooperative Oncology Group) before and after rehabilitation were analyzed, and threshold value of home discharge was calculated from a receiver operating characteristic curve (ROC). General criteria for home discharge from our hospital included independence in performing basic activities of daily living such as bathing, feeding, and toileting or availability of home support from a family member/caregiver. RESULTS: The outcomes after rehabilitation among all the patients were as follows: discharge home 59%, death 13%, and others 27%. Statistical differences were observed between the initial and final values of the Barthel index in patients with bone metastasis, who could be discharged home (p=0.012). ROC analysis of the initial Barthel index for predicting home discharge revealed a threshold value of 60, sensitivity of 0.76, and specificity of 0.72. CONCLUSION: The patients with bone metastasis had a lower rate of home discharge and a higher rate of mortality than all the study patients who underwent cancer rehabilitation at our hospital. It is proposed that at the time of initiation of rehabilitation for patients with bone metastasis, an initial Barthel index lower than 60 might predict a worse outcome than home discharge.
Activities of Daily Living ; Asian Continental Ancestry Group* ; Baths ; Humans ; Mortality ; Neoplasm Metastasis* ; Rehabilitation ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome