OBJECTIVE: The present study assessed the validity of the benchmark, 75 years old, that divides elderly people into an early and a late stage, based on health checkup results for two consecutive years. We also investigated prevalent health problems and improvement trends.
METHODS: This retrospective study was conducted on 1,416 subjects (1,007 early and 409 late elderly subjects) who received health checkups at the Health Care Center of the St. Marianna University School of Medicine Hospital between April 2006 and March 2007. The survey consisted of blood pressure, required blood test results, diagnoses according to the criteria defined by Kawasaki city, outcomes, and the presence or absence of a primary care doctor.
RESULTS: The number of subjects with anemia and/or renal dysfunction was significantly greater in the late elderly than the early elderly (p<0.01). The results of the survey demonstrated that 79.6% of the early elderly and 87.4% of the late elderly had primary care doctors (p<0.01). In the early elderly, 57.0% of the subjects with primary care doctors and 43.2% of those without primary care doctors showed improvement; the subjects with primary care doctors showed significant improvement compared to those without primary care doctors (p<0.05). In the late elderly, 50.2% of the subjects with primary care doctors and 54.2% of those without primary care doctors showed improvement, resulting in no significant difference between the subjects with and without primary care doctors.
CONCLUSIONS: We found differences in the detected health problems and outcomes between the early and late elderly. These results support the appropriateness of the current age segmentation and future prospects for medical care in detecting and managing health problems in the elderly.

We report the case of a 63-year-old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.

 Our hospital comprises nine departments of internal medicine that specialize in different organs, and the Department of General Internal Medicine is one of these departments. The inpatient department has 30 beds for providing medical care, and education is provided for junior and senior residents. We examined the diagnoses in 593 cases (289 men, 304 women ; mean age, 64.2±21.2 years old) who were hospitalized in the Department of General Internal Medicine at this hospital between April 2007 and March 2008. The major diseases included pneumonia, 111 cases ; urinary tract infections, 44 cases ; infectious enteritis, 34 cases ; bronchial asthma, 24 cases ; fever of unknown origin, 12 cases ; heart failure, 11 cases ; viral infections 9 cases, diverticulitis, 8 cases ; malignant lymphoma, 7 cases ; infectious mononucleosis, 7 cases ; polymyalgia rheumatica, 6 cases ; and others. In order to provide diagnoses and treatments for cases in which no diagnosis could not be obtained on the first outpatient visit, for example, it is necessary to have a ward for general internal medicine as a location for providing medical care that is not limited to any specialized field.

We report the case of a 34-year-old man who was initially diagnosed with a tension-type headache after complaining of a headache and nausea. His headache worsened in severity and it was exacerbated on standing in the upright position. The patient was admitted to the hospital on suspicion of spontaneous low cerebrospinal fluid (CSF) pressure headache. Gadolinium-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement, brain sagging, cerebellar tonsillar herniation, brainstem descent and a subdural hematoma. Successful emergency surgery was undertaken.
Spontaneous low CSF pressure headache syndrome is characterized by orthostatic headache, and if such a headache worsens, clinicians should consider a subdural hematoma, a life-threatening complication of this unusual disorder.

In 2015, the Japan Council for Kampo Medical Education was established to create a basic curriculum for Kampo medical education that could be implemented in medical schools nationwide. After conducting a needs assessment, we decided on a lecture time of 240 minutes. To set learning objectives, we formed groups for “history,” “examination methods and patterns,” “effects of Kampo medicine,” “clinical cases,” “acupuncture and moxibustion,” and “evaluation.” The teaching contents were incorporated. Then, model slides and lecture guides containing these teaching contents were created, and textbooks based on these contents were published in 2020. In 2021, these overall efforts and contents were made public nationwide, providing an opportunity for the introduction of this curriculum at each university.

Many papers on medical education emphasize the idea that obtaining structure through the practice of Oral Case Presentations (OCPs) is essential and efficient to brush up presentation skills. However, psychological resistance to giving a public presentation is an obstacle in learning OCPs. The aim of this survey is to evaluate the educational effect of our teaching method using a playful learning approach for presentation. This study was conducted by using an anonymous self-administered questionnaire for medical students during their clinical clerkship. One hundred twenty eight students participated in this survey.　Didactics and small group discussions took place during the first week of clerkship, and participants were asked to give presentations about their original theme during the second week. Questionnaires were distributed before and after the end of each session. The results showed that psychological resistance to presentations decreased, positive feelings increased, and students became more aware of the purpose, place, and subject of their presentations. Each parameter statistically improved at each phase. A playful learning approach is effective in teaching presentations, including OCPs.

At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program, “Pre-graduation and post-graduation Kampo medical education for the next generation,” focusing on Kampo medical education. We summarize and report a mock lecture on standard Kampo medicine conducted jointly with the Japan Council for Kampo Medical Education (JCKME) for the purpose of faculty development. The lecture contents were based on the “Basic Curriculum for Pre-Graduate Education in Kampo Medicine 2016” established by the JCKME, and the common model slides prepared by the JCKME were used. The lectures were pre-recorded for 240 minutes on the “History of Kampo medicine,” “basic theory of Kampo medicine,” “physical examination of Kampo medicine,” “composition and effects of typical Kampo medicines, effects and side effects of typical herbal medicines,” “usefulness of Kampo and clinical cases that were effective,” and “overview of acupuncture and moxibustion treatment,” and were delivered from seven days before to seven days after the annual meeting. This was the first nationwide educational activity for the general meeting of the society. These lectures were viewed 1,017 times nationwide, by medical students, educators, and members of the society.