In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.

This study was performed to clarify the analgesic effect of ketamine injected into the first intercoccygeal (Co1-Co2) epidural space in standing cattle. Five adult cows were randomly received 3 treatments at least 1 week interval: 5, 10 and 20 mL of 5% ketamine. Sedation, analgesia, ataxia and other effects on cardiopulmonary and rumen functions were assessed before ketamine administration and until 120 min. The analgesia without sedation was shown at tail and perineum about 5 min after all three treatments. The duration of analgesia was significantly increased according to the volume of ketamine (p < 0.01). There was a similar tendency of ataxia with individual variation. There were minimal effects on cardiopulmonary and rumen functions. The present study showed that caudal epidural ketamine administration induced analgesia without sedation in cows, and the duration of analgesia was dose dependent with ataxia. However, the duration of analgesia after 5 and 10 mL ketamine administration is short for common surgical procedures and pain relief of perineum. Further studies are needed to prolong the duration of analgesia without side effects.
Analgesia, Epidural/*veterinary ; Analgesics/*administration & dosage ; Animals ; Blood Pressure/drug effects ; Body Temperature/drug effects ; Cattle/*physiology ; Female ; Heart Rate/drug effects ; Ketamine/*administration & dosage ; Respiration/drug effects ; Rumen/metabolism

A questionnaire survey of risk management systems for medical products was conducted with the cooperation of domestic and foreign pharmaceutical companies. As for the foreign companies, it was revealed that specialized safety management teams and data-management committees are established to formulate risk management plans in order to create systems that assure consistent risk management for each company. In addition, it was revealed that toxicologists are incorporated in the central decision making organization. As for domestic companies, it turned out that no less than half of the respondents pay attention to consistent risk management from the development stage through the post marketing stage. From now on, it will be essential to consolidate safety data, improve the accessibility of centralized safety data from the relevant departments, and establish systems to provide consistent risk management from the development stage to the post marketing stage.

Objective: To investigate whether postgraduate education through evidence-based medicine can affect the knowledge and behavior of residents.
Design: Self-controlled and externally controlled trial.
Setting: University hospital.
Participants: Fifteen residents specializing in family medicine.
Intervention: Four 2-hour seminars and weekly evidence-based medicine-style journal club meetings.
Main outcome measures: Scores from a test of knowledge of evidence-based medicine and the number of MEDLINE searches conducted each month.
Results: All residents improved their knowledge of evidence-based medicine and conducted more MEDLINE searches each month than did other medical residents or residents of our department last year.
Conclusion: Postgraduate education through evidence-based medicine is effective in improving residents' knowledge and behavior.

Purpose: This retrospective study aims to evaluate the effectiveness and safety of morphine for the management of dyspnea in terminal cancer patients. Methods: 64 terminal cancer patients, who had morphine administered for dyspnea management, were investigated. Dyspnea was assessed daily on the numerical rating scale (NRS; 0-5) before and 48 hours after the administration, and at the point of dose modifications. Result: The medication period was 34.7 days and the daily dose of morphine was 93.0 mg. The mean NRS decreased from 3.5 to 1.6 (p<0.001). 46 patients (72%) were started with an oral administration of normal-release morphine when-required. The major side effects of morphine, such as hypoxemia or decrease in respiratory rate, were not observed. Conclusion: Morphine is effective and safe for the management of dyspnea even in terminal cancer patients with careful titration.

Purpose: The prefered location for recuperation of cancer patients is constantly changing. In order to meet the request of the patients and their family that they want to stay at home, our answer is to provide a “back-up bed” on the role for our palliative care unit. We developed a 24-hr hot line (Bethel Hospice Hotline; HL), and carried out HL from April 2010. For the purpose of future enhancement of cooperation, we examined the case of HL history over 3 years. Methods: Palliative care physicians interviewed patients and their families, explained the mechanism of cooperation to their family doctors. With their consent patients were registered to the HL. Results: 75 cases of HL registration from April 2010 to April 2013, 63 cases were supported by home care supporting clinics, 7 by other clinics, 3 by other hospitals and 2 others. The demands of family doctors upon HL: 69 cases were back bed and 14 cases required consultation for symptom relief. Our results show 42 (21 were emergency) patients admitted to our hospital, 18 received care at home supported family doctors, 4 were admitted to other hospitals, and 11 are ongoing. Conclusion: Since half of the admissions (21/42 cases, 6 were off hours) to our hospital were emergency, it is necessary to promote efficient cooperation to reduce the burden of the family doctors and the palliative care unit. Thus, it is expected to relieve the symptoms from early stages of the illness and to facilitate timely hospitalization.

Purpose:This study aims to clarify the current situation where palliative care is concurrently performed with cancer therapy, and its effectiveness. Methods:Medical charts of patients cared for at home between April 1, 2012 and March 31, 2013 were retrospectively investigated. Results:14 out of 192 home-care cancer patients were given chemotherapy. The palliative medication period was 192 days and chemotherapy lasted 89.8 days on average. From the beginning of home palliative care until death, patients received chemotherapy for almost half of this period. Consideration:By establishing trust between patients and caregivers, palliative care serves the patients needs well, even after cancer treatment is completed. Home palliative care is a significant part of the entire process.

We report a case of chronic DeBakey type I dissecting aneurysm with an aberrant right subclavian artery, in which replacement of the ascending aorta and the transverse aortic arch was performed under selective cerebral perfusion, resulting in complete obliteration of the false channel in the descending thoracic aorta. A 57-year-old female was admitted to our service complaining of chest and back pain. An aberrant right subclavian artery that originated from the descending thoracic aorta was identified. During operation, the dissected aortic wall of the aortic arch and the proximal descending thoracic aorta that involved more than half of its circumference was resected, the dissected intima was reapproximated at the distal stump, and the beveled distal end of the tubular ascending aortic prosthesis was secured to the cut edge. The postoperative course was uneventful, and she is leading a normal life now four years after surgery. It is rare to reconstruct the aortic arch for aortic dissection that occurred in a patient with aberrant right subclavian artery, and the technical details were reported.