More than 2 years have passed since the new postgraduate clinical training program was instituted in 2004 to improve the clinical ability of Japanese physicians. However, there have already been discussions about whether the undergraduate curriculum and the postgraduate program should be improved.
After the first physicians finished their training under the new program in the spring of 2006, questions were raised about whether the identical final goals of training could be achieved by transferring some items of postgraduate clinical training to the undergraduate period. Such a change might invigorate the undergraduate curriculum and enhance the effectiveness of the postgraduate program.
1) Are-evaluation of the final goals of postgraduate clinical training might allow some items to be taught during the undergraduate period.
2) Several questionnaires were sent to 211 supervising physicians and 184 first-year residents who had just completed the new internship program at 25 teaching hospitals (university hospitals and postgraduate training hospitals).
3) Both trainees and supervising physicians reacted positively about and expressed a willingness to participate in training items, including noninvasive diagnostic procedures and laboratory studies not harmful to patients, during advanced courses in the undergraduate period.
4) Both trainees and supervising physicians reacted negatively to participating in any invasive procedures that might affect a patient's welfare or sense of shame during the undergraduate period.
5) In the future, training with simulated procedures before actual patients are encountered and enlisting enough supervising physicians are essential for unifying the undergraduate medical school curriculum and postgraduate clinical training programs.

　　With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test) to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.

Objective：It is often difficult to provide effective functional training in patients with severe attention deficit caused by organic damage to the brain. Herein, we report a case of attention deficit in a patient with subarachnoid hemorrhage, which was successfully treated by virtual reality (VR)-guided rehabilitation.Methods：A 71-year-old woman was transferred to our hospital for rehabilitation after a subarachnoid hemorrhage. The patient suffered from severe attention deficit. She was unable to follow instructions from therapists and was unable to concentrate on rehabilitation tasks. We attempted VR-guided rehabilitation using mediVR KAGURA (mediVR, Toyonaka, Japan) in order to improve her attention deficit. The training was performed approximately 20 min every weekday, for 4 months in a 360-degree VR environment, with no background image initially. The difficulties in physical and cognitive tasks were adjusted by focusing on the size, range of appearance, and falling speed of each task object, so that even patients with severe attention deficit could respond to these tasks appropriately.Results：After the above-mentioned VR-guided training, the trail making test A, behavioral inattention test, and moss attention rating scale were improved from 300 s (could not complete the test）to 100 s, 119 to 133, and 55 to 98, respectively. In addition, in the clinical assessment for attention, the time required for visual obliteration tests was significantly shortened, and clinical symptoms associated with attention deficit were also improved clinically.Conclusion：VR-guided rehabilitation has the potential to be used as a new therapeutic approach to improve attention deficit.

Objective: The placebo effect can enhance the response to treatment, even in the absence of pharmacological ingredients. One possible factor explaining the likelihood of the placebo effect in individuals is genetic polymorphisms in neurotransmitters. This study focused on gene polymorphisms in the catechol-O-methyltransferase (COMT) as an interindividual variable of the placebo effect.Design・Methods: All 120 participants were explained the effects of caffeine, including its ability to ameliorate drowsiness and increase concentration, and then given a placebo (lactose). The onset of the placebo effect was measured in terms of the degree of caffeine-reduced sleepiness using subjective indices of the Stanford Sleepiness Scale (SSS) and a feeling of drowsiness-Visual Analogue Scale (VAS). The mechanism of the placebo effect was objectively examined in terms of changes in cerebral blood flow in the prefrontal cortex of the brain. In addition, we investigated participants’ susceptibility to the placebo effect by examining genetic polymorphisms in COMT.Results: After taking the drug, sleepiness on the SSS and VAS was significantly improved (p＜0.001), although there was no change in prefrontal cortex activity. Among the 120 participants, 63 had a Val/Val-type polymorphism in COMT (52.5%), 45 had a Val/Met-type (37.5%), and 12 had a Met/Met-type (10.0%). There were no significant differences among COMT gene polymorphisms in the subjective measures of SSS and VAS. However, there was a tendency for the cerebral blood flow changes to be larger in the left hemisphere of the brain in individuals with the Met/Met type.Conclusion: There seems to be a relationship between prefrontal cortex activity and genetic polymorphisms. In particular, there may be a correlation between the expression of a placebo effect and COMT gene polymorphisms.