At the Fujita Health University School of Medicine, about 30% of medical students are admitted on the basis of recommendations.To evaluate the performance of these students after admission, a placement test was given to all new students just after the entrance ceremony to examine basic academic abilities.The scores were compared with the number of absences from lectures and with examination results for the first and second years.
1) The 398 students admitted from 2002 through 2005 were classified into three populations: 126 recommended students, 137 students who scored in the top half on the entrance examination, and 135 students who scored in the bottom half.
2) Scores on the placement test were highest for the top-half students, intermediate for the bottom-half students, and lowest for the recommended students.Scores on examinations in the first and second years were highest for the top-half students, intermediate for the recommended students, and lowest for the bottom-half students.
3) The average number of absences from lectures in the first and second years tended to be lower for recommended students than for the top-half or bottom-half students.
4) The examination scores in the second year were correlated with scores in the first year, and the average number of absences in the second year correlated with those in the first year.
5) These results indicate that the motivation of students in each classification to study in the 1st year is, in addition to their basic academic abilities obtained in high school, an important factor affecting their performance in the second year and beyond.

A 60-year-old man was admitted to our institution with abnormal ECG findings. Coronary CT and angiography showed coronary aneurysms from the left main trunk to the bifurcation of the left anterior descending artery, and the left circumflex artery, with severe stenosis and complete obstruction of the proximal right coronary artery. Morphological evaluation findings strongly suggested that the coronary aneurysms were highly related to childhood Kawasaki disease. We successfully performed triple vessel coronary artery bypass grafting. Here, we report a very rare case of coronary aneurysms presumed to be due to childhood Kawasaki disease in an elderly man.

In the present study, surveys regarding the philosophy of learning were administered just after the entrance ceremony to all students entering the Fujita Health University School of Medicine in 2005 and then, once more, to the same students during the last term of the fourth year, so that the data could be subsequently analyzed. The 87 fourth-year students who completed the surveys were divided into 3 groups(top, middle, and bottom thirds)on the basis of their examination scores in the previous years.
1) Results of the fourth-year survey suggested that students in the middle or bottom third did not develop a "learning-centered campus lifestyle" during their 4 years of medical studies, although the first-year survey indicated that most students in all 3 thirds had desired such a lifestyle.
2) The image of a physician had changed somewhat for students in middle or bottom third but not for students in the top third.
3) Attendance rates in all years of medical study were lower for students in the bottom third than for students in the middle or top third. Moreover, the motivation to study and attend lectures showed a downward trend over time for students in the bottom third.

1)We reproduced a problem–based learning (PBL) tutorial at our school and developed our own PBL tutorial, which we call "Fujita–style PBL." This is a clinical problem-solving type of PBL, in which both a monitoring room and small–group learning rooms are used.
2)To maintain the present number of PBL lessons despite the limited number of tutors, one tutor supervises several groups simultaneously. Coordinators observe the progress of PBL from a monitoring room and support the tutors.
3)Students learn the given scenario and identify their learning issues. After they study the learning issues by themselves, the students return to tutorials to explain their learning issues. Thereafter, each group's findings are presented to the groups supervised by one tutor.

1）To learn the techniques required immediately after the start of clinical practice, new residents were introduced to the skills laboratory during their orientation period.
2）We attempted to establish the Yanegawara style, which is an overlapping teaching style in which the second–year residents plan the entire training schedule and simultaneously teach the first–year residents while being supported in their teaching by more senior physicians.
3）Training with the new system resulted in greater rapport among all residents as well as a greater feeling of security among first–year residents.

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.