1) Japan Society for Medical Education launched a committee for the graduate education of medical educationists in Japan. The committee proposed a direction toward establishing the system, by way of discussion among the members, needs assessment, information gathering of overseas master courses, and discussion at the open meeting.2) To promote medical education in Japan, we should establish 2 systems concurrently: (1) a graduate education for medical educationists who have a broad base of theories and can lead future medical education, and (2) a broader certificate system for medical teachers who have good practical teaching skills.

1) The committee for the graduate education of medical educationists, Japan Society for Medical Education, investigated needs for the education system of medical educationists.2) A questionnaire was sent to 1831 leaders in healthcare education and the society members, and 644 replied (recovery rate 35.2%). Fifty % of the respondents agreed the necessity of medical educationists. Certificate level was most popular, however, master and PhD degrees were also considered to be necessary. 3) These results support the establishment of educational system for medical educationists in Japan.

Introduction: The purpose of this study was to clarify the relationship between the available service information on small-scale multifunctional in-home nursing care (KANTAKI) and its operational status via text mining.Methods: We obtained nationwide textual information on KANTAKI from the Nursing Care Service Information Disclosure System and the Ministry of Health, Labour, and Welfare, and analyzed the characteristics of the word usage using KH Coder. The number of users and employees and the implementation of services were compared among the facilities that used terms relating to medical dependency and end-of-life care, which are KANTAKI characteristics, and with other facilities.Results: The facilities that used terms relating to medical dependency and end-of-life care showed significantly more users requiring nursing care level 5 and more full-time nursing staff than those not using such terms. Moreover, regarding service provision, the rate of procedures was significantly higher in 11 of 12 items, except for stoma.Conclusion: The facilities that use terms relating to medical dependency and end-of-life care in their information have more users and provide a greater variety of services. In the future, educational support is required to enable facility managers to understand the services and translate them into their work.

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.

A survey was conducted to determine the current status and issues of dysphagia care in hospitals and long-term care facilities in Gifu Prefecture. Responses were obtained from 14 hospitals, 13 welfare facilities for elderly adults requiring long-term care (WFs), and 13 geriatric health services facilities (GHSFs). Dysphagia teams were present at 12 hospitals, 4 WFs, and 8 GHSFs. The teams primarily consisted of general nurses (hospitals = 12, WFs = 4, GHSFs = 8; same order below), certified dysphagia nurses (11, 1, 0), nutritionists (11, 4, 7), speech-languagehearing therapists (11, 0, 5), physicians (7, 2, 4), and pharmacists (7, 0, 0). Facilities that employed certified dysphagia nurses conducted screening for dysphagia, but many hospitals and long-term care facilities did not review patients’ medications to identify medications that could cause dysphagia. In addition, many hospitals did not educate care workers about assisting with eating and swallowing. This demonstrates a need to improve dysphagia-related screening and educational systems for nurses and care workers at hospitals and long-term care facilities.

Introduction: Antiepileptic drugs were occasionally administered to manage seizures in terminally-ill cancer patients. When enteral route is no longer feasible due to dysphagia or depressed level of consciousness, subcutaneous route could be an option. We reported three cases of terminally cancer patients who received subcutaneous levetiracetam (LEV) due to an inability to administer via intravenous route. Cases: The age of 3 cases was 83, 75, 82 years, respectively. In all cases, the prognosis prediction at the start of subcutaneous LEV was about 1 month. In all cases, the route of administration of LEV was changed from intravenous to subcutaneous. No exacerbation of convulsions, or injection site reaction was confirmed after subcutaneous LEV administration. Discussion: We believe that subcutaneous LEV administration may be one of the treatment options for seizures in patients with terminal cancer for whom intravenous administration of LEV is no longer feasible.

Introduction: Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma. Patients with IVLBCL frequently have neurological symptoms associated with cerebrovascular infarction or central nervous system involvement of malignant lymphoma. Case: A 67-year-old man consulted the Department of Hematology at our hospital because of fever of unknown origin, anemia and increased serum lactate dehydrogenase. Although IVLBCL was strongly suspected, no lymphoma cells were found by multiple bone marrow aspirations and skin biopsies. Two months later, he developed hyperactive delirium, which was difficult to manage using antipsychotic agents. Brain MRI revealed multiple hyper-intense infarct-like lesions on diffusion-weighted images. After assessment of bone marrow aspiration and skin biopsies, he was administered an enough dose of prednisolone to manage malignant lymphoma. Hyperactive delirium rapidly improved. Discussion: In patients with IVLBCL, corticosteroids may be useful to manage hyperactive delirium due to cerebrovascular infarction or central nervous system involvement of IVLBCL.