This study was to examine the relationship between bone maturation scores and the nutrition indexes, and to consider the estimated range for the evaluation of bone maturation scores. This study investigated the relationship between the bone maturation scores and the nutrition indexes of compound variables of height, body weight and sitting height, by the correlation coefficients in eleven items and used them as raw data for analysis.
The obtained results were as follows
1. The correlation coefficients between the nutrition indexes and bone maturation scores (Middle Phalanges) showed that in the second sexual period boys were significance at the level 0.05 in all the Rohrer, Kaup and Kawahata indexes. Each of them were as follows : Rohrer index 0.325, Kaup index 0.415, Kawahata index 0.485. In the girls also the correlation coefficients showed significance between the Rohrer, Kaup, and Kawahata indexes of all three phalanges scores, especially in correlation with the Middle Phalanges scores : Rohrer index 0.458, Kaup index 0.540, Kawahata index 0.424.
2. If the bone maturation scores are evaluated by the three nutrition indexes, it may be estimated that the bone maturation scores are evaluated by the Middle Phalanges scores for both boys and girls.
Regression Equations and the Standard Error (SE.) of estimate are as follows
Rohrer Index ; Boys : Y=12.42+0.75X, S.E.=±0.15
Girls : Y=10.00+1.55X, S.E.=±0.38
Kaup Index ; Boys : Y=10.48+0.62X, S.E.=±0.21
Girls : Y=8.23+1.13X, S.E.=±0.35
Kawahata Index ; Boys : Y=10.47+1.82X, S.E.=±0.21
Girls : Y=12.08+2.66X, S.E.=±0.29
note : X (nutrition indexes) Y (bone maturation scores)
3. The S.E, of estimated scores in bone maturation scores which were obtained by using each the nutrition index scores of the estimate equations were very small and the results of t-Test in the means of estimated scores and the means of actual measurement showed hardly any significant difference at the level 0.01. According to these results the estimate equations used here were considered to be of higher reliability.
4. The bone maturation scores were compared with the two groups, good and poor, classified by the nutrition indexes. In the case of the boys there was no significant difference in the Rohrer index.
But according to the Kaup and Kawahata indexes there were significant differences in each part of the bone except for the Proximal Phalanges scores. In the girls there were equally significant differences in all three nutrition indexes of the good-poor groups.
From the results found in this study, the nutrition indexes may by considered as an index to estimate the bone maturation scores, at least, of junior high school students in growing period.

A 56-year-old man was admitted to our hospital for the purpose of rehabilitation. Because this patient developed apallic syndrome 21 days after he recovered from his first coma, he was diagnosed with the interval form of carbon monoxide (CO) poisoning. On admission, he showed paralysis of all limbs, motor dysfunction due to joint contractures, pain, and higher brain dysfunction. These symptoms were consistent with magnetic resonance imaging (MRI) findings that the frontal white matter was mainly affected while the involvement in the basal ganglion was mild. Rehabilitation was continued, and his motor dysfunction was improved in a few months, although the higher brain dysfunction needed a longer term to improve. An interruption of his rehabilitation resulted in the exacerbation of the motor dysfunction. Subsequent complications of CO poisoning have been reported to be linked to the areas of the involvement revealed by MRI. Since CO poisoning can show various symptoms, a diversity of rehabilitation is required, according to the patients' symptoms. We think that rehabilitation is the most effective therapy for the subsequent complications of CO poisoning. Since the symptoms require a long time to improve, it is difficult to deal with them within the application of the existing health insurance and nursing care support regulations. We consider that rehabilitation for motor dysfunction and higher brain dysfunction are important, in addition to hyperbaric oxygen therapy in the acute stage of CO poisoning.

Objective: To compare effects of the fluoropyrimidines S-1 and capecitabine on prothrombin time international normalized ratios (PT-INR) of warfarin following coadministration and after discontinuation of each fluoropyrimidine treatment.
Methods: Medical records of patients receiving warfarin with either S-1 (6 patients) or capecitabine (7 patients) were obtained from four hospitals.
Results: Increased PT-INR was observed until peak levels of warfarin were achieved in all patients in S-1 and capecitabine treatment groups.　Moreover, PT-INR significantly changed after coadministration within each group (p＜0.05).　Specifically, ratios of peak PT-INR after coadministration of each fluoropyrimidine and those following administration of warfarin alone (PT-INR elevation ratio) were 3.31 and 3.29 in S-1 and capecitabine coadministration groups, respectively.　Moreover, numbers of days to peak PT-INR were 38.3 and 31.3 days, respectively, and did not significantly differ between the treatment groups.　Furthermore, PT-INR returned to pretreatment levels by 17.5 and 15.1 days after discontinuation of S-1 and capecitabine, respectively, and did not significantly differ between the treatment groups.
Conclusion: Coadministration of S-1 and capecitabine similarly prolongs PT-INR by approximately 3-fold compared with administration of warfarin alone; therefore, these drug-drug interactions were clinically suggested to be of high risk for episodes of bleeding and remarkable alterations in coagulation parameters.　Therefore, blood coagulation ability should be more carefully monitored with regard to PT-INRs in patients receiving warfarin with S-1 or capecitabine not only during coadministration but also after discontinuation of fluoropyrimidine treatments.

In Japan, the revised Immunization Law was enacted in December 2020, and municipalities have promoted a free vaccination project against COVID-19 with the aid of upper prefectural governments under the management of the Minister of Health, Labour and Welfare. To support prompt vaccination for residents over 65 years old, Kawachinagano City Pharmaceutical Association supplied a Prevaccination Screening Questionnaire to all pharmacies in Kawachinagano in cooperation with the local governments and medical associations. We conducted a questionnaire survey on the handling of questionnaire forms at pharmacies and the content of consultation by residents regarding vaccination, and investigated the significance of community pharmacy in regional medical activities by analyzing the responses. By the end of May 2021, the number of questionnaire forms provided to residents from pharmacies of the Kawachinagano City Pharmaceutical Association was approximately 3,000, which was attributable to the efforts of each pharmacist in almost all pharmacies to individually offer sincere consultation services to residents. In addition, residents were markedly concerned about pharmacotherapy, with the frequency of consultation by residents being higher about “treatment details, including drug use” and “adverse reactions of the vaccine.” Our study revealed that community pharmacies of the Kawachinagano City Pharmaceutical Association largely contributed to the smooth implementation of vaccination by performing routine work originally dealt to the local governments and medical institutions, which strongly suggests that community pharmacies fulfill their mission corresponding to social needs even during a pandemic.

Under the current postgraduate clinical training system for physicians, three principles have been emphasized in its basic tenets; cultivation of character appropriate for physicians, generation of awareness to the societal role of medical science and healthcare, and mastery of basic clinical skills needed to respond appropriately to injuries and illnesses frequently encountered in general practice. In accordance with its quinquennial review rule, the Clinical Training Committee under the Medical Caucus of the Healthcare Professions Council released draft revisions of a notification published by the Director general of the Health Policy Bureau of the Ministry of Health, Labor and Welfare in March, 2018. The document is entitled "On the operation of the ordinance concerning the postgraduate clinical training prescribed in the paragraph (1) of Article 16-2, Medical Practitioners Act" .　A Key distinction of the revised draft is new learning outcomes featuring core values shared by physicians: commitment to physicians' societal mission of public health, altruistic behavior, respect for humanity, and maintaining one's own integrity. Another key distinction is securement of longitudinal consistency in the set of required faculties, from medical school curriculum to continuing professional development programs. Further improvements in systems and environments to enhance devotion to life-long learning are needed.

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

Objective: In order to ensure the safety of nursing home residents, it is very important to implement appropriate assistance to ensure compliance with necessary medication. The purpose of this study is to identify issues and to plan solutions for medication assistance.Design: We conducted a workshop involving care workers (CWs), nurses and pharmacists together.Methods: Using the KJ method, participants extracted problems related to medication assistance and planned solutions in a mixed group of CWs, nurses and pharmacists. Questionnaire surveys were conducted for the participants before, immediately after, and 3 months after the workshop.Results: A number of important and urgent issues related to medication assistance were identified. There were differences in the recognition patterns of the importance and urgency of the issues among the three categories of participants. In addition, many possible solutions were proposed. Among these solutions, 25% had been implemented by at least two participants. More than 75 % of participants felt that their awareness of the value of cooperation in medication assistance had been improved by participating in the workshop.Conclusion: These results suggest that a workshop with a group of CWs, nurses and pharmacists in one place is a useful approach for extracting problems and planning effective solutions related to cooperation in medication assistance.

The mortality rate of pediatric out-of-hospital cardiac arrest is more than 80% in Japan, which is markedly higher than that in adults. Basic life support (BLS) by bystanders is essential for preventing sudden cardiac death. In the model core curriculum for pharmaceutical education in 2024, students must acquire the ability to ensure public health. As part of our educational policy, pharmacy students provide a workshop on infant BLS. This workshop is incorporated after the PUSH course, an authorized training program for BLS focused on chest compressions and AED use of people over elementary school age, for convenience. We herein investigated whether infant BLS training promoted the comprehension of and motivation to perform BLS for infants and assessed the educational relevance of pharmacy students serving as instructors of the BLS training course. Questionnaire responses were obtained from participants before and after the workshop. The majority of participants were college students and childcare workers. Knowledge of infant BLS by childcare workers was significantly more extensive than that by the other participants; however, overall understanding of infant BLS and the motivation to contribute to it increased irrespective of participant backgrounds. Overall improvement was also observed in the items necessary to implement BLS excluding artificial ventilation even though the instructions were given only by pharmacy students. The present results demonstrate that infant BLS training effectively enhanced public motivation to perform BLS for infants with cardiac arrest.

Medical education towards a specialty is a core stage of training for medical doctors. The specialty training system in Japan was initially organized by various academic societies and was recently integrated under Japan Medical Specialty Board, which was established in 2014. From April 2018, a revised specialty training system will begin and be based on new program guidelines. Its main concepts are professional autonomy, quality assurance of the medical specialty board and trustworthy medical consultation. As with undergraduate education, global standards are recently required in postgraduate education. Consistent outcome policy throughout undergraduate and postgraduate education and workplace-based assessment can hopefully be established.

A community-based medicine program in the postgraduate clinical training system has been offered as a mandatory program since 2004. Training sites range from clinical attachments in rural/remote areas to public health centers in the city. The role of the program director is important for enhancing the community-based medical program and raising resident doctors. Unique training programs have been carried out, such as medical training in the afflicted area of the earthquake/Tsunami disaster area as well as an exchange program between Hokkaido and Kagoshima residents. The Japanese healthcare system is drawing global attention and local demand. Enrichment of the community-based medicine program is vital for the human resource development that makes the Japanese healthcare system innovative and sustainable.