Since the statement made by the ECMFG, WFME Global Standards have been focused on by medical departments, and pre-graduate behavioral science education which is one of the requirements included in these standards has gained prominent attention in Japan. In Japan's society, where the birthrate is decreasing and the population is growing older, physicians are required to have a patient-centered viewpoint instead of focusing on specialized treatment and hospital-oriented medical care. It has been 10 years since early clinical training became mandatory, and there is a need to develop medical education that allows physicians to nurture their professionalism and clarify their types of competence. In addition, using materials and strategies necessary for medical practice, medical departments need to provide education in practical medical behavioral science that facilitates the comprehensive learning of professionalism, medical ethics, NBE, and medical safety.

JA Hiroshima General Hospital has 578 beds, and the Psychiatric Department, founded in 1994, is staffed with two doctors without beds. On June 1, 1999, the Intensive Care Unit (ICU) was newly established in the hospital. Forty-two inpatients in the ICU were referred to us during the one-year period following the establishment of the ICU in our hospital. We investigated the reasons for consultation, somatic and psychiatric diagnoses, and outcome, and compared our findings with the results of the surveys conducted by other hospitals with psychiatric units. Our investigation revealed that “suicide attempt or suicidal ideation” was highest on the list of reasons for consultation, “acute drug intoxication” was highest on the list of medical diagnoses, “adjustment disorder” was highest on the list of psychiatric diagnoses, and that “discharged from ICU” was highest of outcomes. Compared with other reports, we had small percentages of “treatment for combined medical and psychiatric illness” among the reasons for consultation, and “schizophrenia” among psychiatric diagnoses, while we had higher percentages of “adjustment disorder” among psychiatric diagnoses, and “being transferred from the ICU to a medical ward” among outcomes, In view of the riskmanagement program at the hospital, we often felt there is difficulty treating physical diseases in psychiatric patients, especially patients who have made suicide attempts in medical wards. Therefore, we consider triage may be one of the most important functions of a psychiatic department without beds. To coordinate our roles successfully, it is necessary to build an effective network with other psychiatric institutions.

　In the 18th workshop of educators on post-graduates in Tokai University Hospital as faculty development, we held a unit of ″Career Design for Residents″ . The association between the changes in the social structure and career development of doctors was first shown, and the background of the necessity of career support was outlined. In addition, participants experienced the use of a worksheet for residents' career instruction. In the review of the workshop, the necessity of organic coordination in group guidance by the training division with individual counseling by mentors was suggested. We will continuously offer career education as career path support.

Objectives: To determine the relationship between obesity and cardiac autonomic nerve activity in healthy children. Methods: 16 healthy male children comprising of 9 nonobese and 7 obese subjects (body mass index > 19.1 kg/m2) aged 8−9 years were selected. Electrocardiograms were measured for 10 min. under controlled ventilation (0.25 Hz) in the supine position. Consecutive 256-second RR interval data were transformed by the Fast Fourier Transform method into power spectral data. Very low frequency (VLF; 0.003−0.04 Hz), low frequency (LF; 0.04−0.15 Hz), high frequency (HF; 0.15−0.40 Hz), and total power (TP; 0.003−0.40 Hz) were calculated and transformed into a natural logarithm (ln). Normalized units (nu) were also calculated as follows: LFnu = LF / (TP - VLF) x 100. HFnu = HF / (TP - VLF) x 100. Low/high-frequency ratio (LHR) was calculated as LF divided by HF. Unpaired t test was performed to compare the 2 groups. Results: TP ln and HFnu, reflecting cardiac parasympathetic nerve activity, in obese children were significantly lower than those in nonobese children. In contrast, LFnu and LHF, reflecting cardiac sympathetic nerve activity, in obese children were significantly higher than those in nonobese children. Conclusions: These findings suggest that obese children have higher sympathetic nerve activity and lower parasympathetic nerve activity than nonobese children.
Child ; Hz ; Cardio- ; Nerve ; With frequency

PURPOSEIt is known that a moderate to large volume of alcohol produces deterioration in obstructive sleep apnea (OSA), however, no consensus has been achieved with respect to the influence of a moderate volume of alcohol on mild to moderate OSA. In this study, we investigated the influence of alcohol on OSA-associated parameters in healthy middle-aged males drinking a moderate volume of alcohol (<1 g alcohol/kg bodyweight per day).

METHODSSubjects were 23 healthy males (mean age of 46.0) with a habitual ingestion of moderate a mounts of alcohol. Respiratory sleep parameters were measured through the fitting of an Apnomonitor III (Chest Inc.) and portable sleep monitoring device (Actiwatch: AMI Inc.) to subjects on three nights; an alcohol-free night, a night on which they drank alcohol with dinner, and a night on which they drank alcohol within 30 minutes before retiring to bed. The measurements were categorized into the early and late halves of assumed sleep for analysis.

RESULTSThe apnea-hypopnea index was significantly higher when drinking alcohol before retiring [mean (SD): 7.8 (8.2) events/hour] than the values on the alcohol-free day [2.9 (4.5) events/hour] and when drinking alcohol with dinner [3.8 (5.3) events/hour]. Furthermore, drinking alcohol before retiring resulted in lower arterial blood oxygen saturation (SpO(2)) during the early half of sleep [94.8 (1.4) %] when compared to the values on the alcohol-free day [95.7 (1.3) %] and drinking alcohol with dinner [95.4 (1.6) %]. In addition, the percentage of time with SpO(2)<92% (hypoxic event) during the early half of sleep [4.9 (9.3) %] was significantly higher than the values on the alcohol-free day [1.2 (1.8) %] and when drinking alcohol with dinner [1.4 (1.8) %].

CONCLUSIONThese results suggest that moderate ingestion of alcohol within 30 minutes before retiring aggravates OSA-associated parameters in healthy males.

Background: For enhancing nursing education, we conducted concept synthesis and empirical validation of the essential genetic/genomic nursing competencies on cancer medicine for all nurses.　Methods: First, 41 articles were reviewed to produce a prototype concept of the essential genetic/genomic nursing competencies on cancer medicine (Study A). Second, focus group interviews were conducted with 21 standard-level nurses in cancer care, genetic/genomic nursing practices were extracted, and these were synthesized into Study A results. Consequently, although two new nursing practices were generated, analysis was terminated because no new concepts were created (Study B). Lastly, two experts performed empirical validation for all subjects.　Results: The following seven concepts were identified: "Utilization of genetic/genomic information," "Prevention of cancer including family members," "Adjustment of genome-related resources," "Attitude toward diversity in individuals," "Fulfillment of basic responsibilities," "Acquisition of specific medical knowledge," and "Awareness of the contribution of genetic/genomic medicine."　Discussion: Compared with the existing genetic nursing core competencies, cancer management systems and technological reforms have led to the addition of "administration management of molecularly targeted drugs" and "harmonization with organizational and regional policies." Thus, the nursing practice behind the concept has shifted from the legally prescribed "medical treatment for injured and ill persons" to "assistance in medical care" involving family members. Others concepts included core competences of general genetic/genomic nursing similar to cancer care.