The number of the patients requiring rehabilitation has been rapidly increasing. Rehabilitation patients and their families face various troubles and problems in their illness, their functional state, their convalescence, and a wide range of domains including their at-home life and care burden. And rehabilitation staffs must deal with these problems appropriately and take pride in their efforts and strive to provide continuing reliable care. However, most hospitals and rehabilitation centers only have one or at most a few physiatrists. Thus, most physiatrists and co-medical rehabilitation staff have few advisers and are frustrated by the many kinds of problems faced in providing medical service and management. In this lecture, I discuss how to build safety measures, how to write medical records to prevent future troubles, the proper on-site manner, and the 15 traits of a disliked physiatrist. I hope that this lecture can blow away the frustration from the rehabilitation scene and be helpful not only for patients and their families, but also for physiatrists and co-medical rehabilitation staff.

The Great East Japan Earthquake occurred on March 11, 2011. As a representative of a local earthquake relief headquarters, I report what we have done in the stricken area following the Great East Japan Earthquake for the three months afterwards. As a result of this report, I strongly recommend the establishment of a “Disaster Rehabilitation” and “Disaster Acute Rehabilitation Team (DART)” as well as creating a “Disaster Rehabilitation Manual or Guideline” in order to pass the knowledge learned through our experience on to future generations and to be able to respond to any forthcoming disaster quickly and efficiently.

Subacute myelo-optico-neuropathy (SMON) is a neurological disorder caused by an anti-diarrhea drug, chinoform. It was not easy to find the cause of SMON, because chinoform was believed to be one of safe drugs. Prescription of chinoform was stopped temporary to investigate the cause of SMON, then there were no new cases of SMON and SMON was confirmed to be caused by chinoform. It was not easy to find all of the side effects of new drug on clinical trials, especially adverse drug reactions (ADRs) emerged following a long administration. Because the duration of trials was not long enough and the number of patients was small. Drugs, especially new ones, should be kept under watch following marketing to find ADRs as soon as possible. Insert packages of most drugs for neurological or mental disorders give warn not to let patients to drive because of sleepiness induced by the drugs. However there are no information showing how much risky to drive on taking the drug. It is not appropriate to inhibit driving legally on taking the drug, but the drug should have any information in the insert package how it is risky on driving under the drug.
 Drug-drug interactions are one of important issues on the treatment. The information in the insert package says physicians should be careful in prescribing drugs on drug-drug interactions. However, in many drugs applied in the treatment, there are no information how much the interaction affects pharmacokinetics of the drug in the insert package. It is essential to know the pharmacokinetics of drug interactions. In putting the warning of drug-drug interactions, the information how much it effects the pharmacokinetics of the drug should be given in the insert package.
 Pharmacovigilance is an essential system to apply new drugs to the therapy. Research and development of new drugs is promoted by pharmaceutical companies and physicians are required to cooperated to develop new drugs, however, on pharmacovigilance, it is essential for physicians to collect the information from their patients properly and to report it promptly. All of physicians should have training on the idea and action of pharmacovigilance on drug treatments.

　As medical safety attracts attention, it has become increasingly important to ensure the quality of medical education, and more emphasis has been placed on educational outcomes. An ideal form of training, in which medical students undergo medical education and then transfer to residency training seamlessly, can be conducted by setting general competencies required for all physicians as educational outcomes, as well as setting milestones in the process. Accomplishing competencies is the pillar of outcome-based education, and the assessment of students' achievements is important.
　The multilateral assessments of their competencies should be conducted, including written examinations, performance tests, observational assessments, and portfolios. In the existing national examination for medical practitioners, no such multilateral assessments are conducted. To promote seamless transition from under- to post-graduate education, it is important for the Faculty of Medicine and medical colleges to appropriately assess students' educational milestones as a condition of awarding them with degrees, in addition to the setting general competencies and such milestones.

　The Japanese Medical Specialty Board has been established with the collaboration of medical and medical care organizations. It ensures the quality of medical specialists and achieves accountability to the people by certifying medical specialists and authorizing training programs. Outcome-based education is characterized by an emphasis on the quality assurance of trained physicians. Therefore, the new medical specialty training system could be constructed through outcome-based education. I give a brief overview of the new medical specialty training system, and it is discussed in the context of the guideline for medical specialty training system published recently.

I report two cases of subchorionic hematoma successfully treated with Tokishakuyakusan. They had genital bleeding due to subchorionic hematoma in the second trimester of pregnancy. I prescribed Tokishakuyakusan, and their genital bleeding improved within a week after the administration. The hematoma disappeared in less than two weeks after the administration, and they delivered infants of 2470g and 3324g respectively at 39 weeks pregnant by vaginal delivery. I found Ketsu stagnation, Sui disturbance and coldness of extremities in two cases. Although several studies suggested that the presence of subchorionic hematoma might be associated with adverse pregnancy outcome, there is no effective treatment for subchorionic hematoma in western medicine. The present cases suggest that Tokishakuyakusan may be useful in the treatment of subchorionic hematoma.
Hematoma ; week ; Cases ; Treated with ; Two