Purpose : The purpose of this study was to review strategies and evidence about effective outpatient precepting in the Western literature.
Methods : The authors searched MEDLINE for studies on family medicine or general medicine outpatient precepting. From 309 papers, the authors applied inclusion and exclusion criteria to identify relevant studies applicable to residency training in family medicine in Japan, and the resulting 18 studies were then analyzed systematically.
Results : Using a dedicated preceptor is the most effective precepting style. In a typical five-minute precepting encounter, most of the time is spent on the diagnosis and management. Insufficient time is spent on the discussion of evidence based medicine (EBM), psychosocial issues, or feedback. To resolve this, precepting techniques such as ‘one-minute precepting’ and SNAPPS can be effectively implemented.
Conclusion : In outpatient precepting, educational discussions incorporating EBM and psychosocial issues as part of standard practice, in addition to providing effective feedback are advocated.

OBJECTIVE: A number of new techniques have been developed to prevent lymphocele formation after pelvic lymphadenectomy in gynecologic cancers. We assessed whether the electrothermal bipolar vessel sealing device (EBVSD) could decrease the incidence of postoperative lymphocele secondary to pelvic lymphadenectomy. METHODS: A total of 321 patients with gynecologic cancer underwent pelvic lymphadenectomy from 2005 to 2011. Pelvic lymphadenectomy without EBVSD was performed in 134 patients, and pelvic lymphadenectomy with EBVSD was performed in 187 patients. We retrospectively compared the incidence of lymphocele and symptoms between both groups. RESULTS: Four to 8 weeks after operation, 108 cases of lymphocele (34%) were detected by computed tomography scan examination. The incidence of lymphocele after pelvic lymphadenectomy was 56% (75/134) in the tie ligation group, and 18% (33/187) in the EBVSD group. We found a statistically significant difference in the incidence of lymphocele between both groups (p<0.01). To detect the independent risk factor for lymphocele development, we performed multivariate analysis with logistic regression for three variables (device, number of dissected lymph nodes, and operation time). Among these variables, we found a significant difference (p<0.001) for only one device. CONCLUSION: Use of the EBVSD during gynecological cancer operation is useful for preventing the development of lymphocele secondary to pelvic lymphadenectomy.
Adult ; Electrocoagulation/instrumentation/*methods ; Female ; Genital Neoplasms, Female/pathology/*surgery ; Humans ; Lymph Node Excision/adverse effects/*methods ; Lymphatic Metastasis ; Lymphocele/etiology/*prevention & control ; Middle Aged ; Neoplasm Staging ; Pelvis ; Retrospective Studies ; Risk Factors

According to the World Health Organization (WHO), mortality by age, sex, and cause of death is the foun­dation of public health both globally and domestically. Comparable mortality statistics over time and investi­gations of mortality were used to develop the International Statistical Classification of Diseases and Related Health Problems (ICD). In the ICD, the WHO states that morbidity statistics are also an essential foundation of public health, but they are much less widely applied. The 10th revision of the ICD (ICD-10) is now in use, but further revisions must be made in the development of the 11th revision (ICD-11) to capture advances in health science and medical practice, to make better use of the digital revolution, and to evaluate traditional medicine (TM). Revision of ICD-10 began in 2007, and an ICD-11 version for preparing implementation was released on July 18, 2018. ICD-11 features a new TM chapter on Japanese traditional medicine, known as Kampo medicine, traditional Chinese medicine, and Korean medicine. ICD-11 will be approved at the next World Health Assembly in May 2019 and will come into effect. This means that the WHO does not currently recognize the effects of TM, but that we as well as the WHO will have hard time to prepare and study the effects of TM on morbidity statistics. It is very important to the study of Kampo medicine that we will be able to properly evaluate the terms and classifications contained in ICD-11.