Quality assessment in primary care is increasingly important, and quality indicators of primary care principles and primary care physicians' tasks are available for policy making and quality improvement in other countries. Patient centeredness is an especially important concept for evaluation of primary care principles, so patient experience surveys using quality assessment tools have been conducted in Europe and the US. On the other hand, similar effective approaches are lacking in Japan. Previous studies have indicated that important primary care principles in Japan are accessibility, comprehensiveness, coordination, longitudinal continuity, interpersonal continuity, community oriented care, and family oriented care. Quality assessment and assurance from multiple aspects should be promoted in the future to improve the quality of primary care in Japan.

Introduction: There are no studies on how much primary care research from Japan has spread internationally. In this study, we aimed to investigate Japan's contribution to high-impact international primary care journals.

Methods: We used the PubMed database and reviewed abstracts to examine the frequency of articles reporting clinical research or systematic reviews originating from Japan that were published in 5 high-impact international primary care journals from January 2011 to June 2016. We calculated the proportion of articles from Japan in the selected journals by year and journal.

Results: Of the total articles (2,602), the proportion of Japanese articles in 5 high-impact international primary care journals was 0.15% (4 articles).

Conclusion: Currently, Japan's contribution to high-impact international primary care journals is very small. In Japan, the development of research infrastructure, the education of researchers, and networks for research collaboration may be needed for international dissemination of primary care research.

In Japan, improving the quality of primary care is an urgent issue; however, there is currently no specialized third-party evaluation program for primary care facilities. In this article, prior to the development of Japan's third-party evaluation program for primary care, we examined the systems and standards for the evaluation of primary care facilities in other countries. Based on the comparison of standards for the evaluation of primary care facilities by third-party evaluation agencies in four countries with Japanese hospital evaluation standards, the standards for collecting and utilizing quality data need to be strengthened from the viewpoint of patients, and areas, such as preventive medicine and home care, need to be covered when developing evaluation standards for primary care facilities in Japan. Moreover, building the structure of the standards with primary care as the main framework will strengthen the function of primary care facilities through continuous quality improvement.

Introduction: The aim of this study was to investigate the current status of patient safety management systems in primary care clinics in Japan.Methods: An online survey on patient safety management systems was conducted among primary care physicians certified by the Japan Primary Care Association who serve as clinic managers.Results: A total of 183 physicians participated in the survey. We found that 53.0%, 73.2%, 38.8%, and 32.8% had developed medical safety guidelines, nosocomial infection control guidelines, drug safety guidelines, and medical device safety guidelines, respectively. Furthermore, 64.5% had fewer than 10 incident/accident reports in the past year, the most common of which were prescription errors, vaccine errors, falls, and needle sticks.Conclusion: The issues identified in this study serve as a basis for promoting the development of educational programs and the creation of evaluation and improvement tools aimed at enhancing patient safety in clinics.

Objectives: The purpose of this study was to investigate current fact of cancer outpatients’ opioid pain management and its possible abusive applications and to establish corrective treatments by the palliative care team. Methods: Our palliative care team investigated cancer outpatients’ prescribed opioid clinical records for 4 months in 2014, and the result revealed inappropriate opioid use which could lead to further abuse or dependency. Through this the team recommended attending physicians viable options including decrease of opioid eventually leading to final withdrawal. Results: Among 67 cancer outpatients, the finding of inappropriate opioid use which could lead to further abuse or dependency was in 5 patients (7.4%). The details are as follows: (1) Three patients were treated with opioid analgesia for initial pain relief but the application continued in spite of recovering from a cancer which had been responsible to the pain. (2) Two patients were medicated with opioid for pain but further diagnosis revealed the disease which caused pain was benign. Four out of 5 patients were successfully withdrawn from opioids. Conclusion: In cancer outpatient settings, it can be overlooked or undetected inappropriate use of opioids which may lead to abuse or dependency without a team approach. To prevent opioid abuses, it is imperative to find the cause of pain as accurately as possible.

Introduction: The aim of this study is to explore career perceptions of male and female medical students.
Methods: Semi-structured interviews to 16 medical students (9males, 7 females) were undertaken.
Results: Qualitative data analysis showed that development of their career perceptions were affected by “gender view”, “interests in medicine” as well as their “perceptions of family”. Specifically, female students in the lower grades felt difficulty in making decisions on career choices due to the conflict between carrying out family responsibilities (e.g., housework and childcare) and interests in medicine. After clinical clerkships, their perceptions of a career were formed in one of two ways: giving priority to family responsibilities or interest in medicine. On the other hand, male students in lower and higher grades consistently gave priority to their interests in medicine for their career choices.
Conclusion: Differing career perceptions between male and female medical students emerged from this study, and supports the need for undergraduate education on gender-equality in society.

 The increase of female physicians and its undeveloped supporting system can be one of the causes of physicians' shortage. Although physicians' marriage/family perceptions and their influences on career choices have been extensively studied, those of medical students are not fully understood. An anonymous questionnaire survey was conducted involving male/female medical students in years 2 and 5 at Gifu University School of Medicine. The results showed that many male/female students hoped to get married, have children, and continue to work in the future, but different perceptions were demonstrated between the sexes with regards to the partners' occupation, working style, and influences of family/marriage perceptions on students' specialty choice. The results suggest the presence of sex-related differences in perceptions among medical students. The survey indicates the necessity of early undergraduate education for a better mutual understanding of gender issues.

The root canal morphology undergoes aging-related changes, and relevant quantitative analyses have not yet been reported. We compared the cone beam computed tomography (CBCT) and micro-computed tomography (microCT) scans of extracted mandibular incisors to check the accuracy of morphological measurements. Thereafter, the root canal morphology and aging-related changes in the mandibular incisors of Japanese individuals were assessed using CBCT.Six extracted teeth were fixed in a phantom head and imaged using CBCT and micro-CT. The correlation between the findings of the two imaging modalities was examined. Further, CBCT reconstructed images of the mandibular incisors of 81 individuals were observed. Age-related changes of the root canals were compared between participants aged <30 years and those aged ≥30 years. The CBCT and micro-CT findings regarding the root canals of the extracted teeth coincided in 94.4% of the cases. Mandibular incisors exhibiting two root canals in either cross-section accounted for 9.9% of central incisors and 12.4% of lateral incisors. Mandibular central incisors with two root canals were observed in two (6.3%) individuals aged <30 years and six (12.2%) aged ≥30 years. Mandibular lateral incisors with two root canals were observed in one (3.1%) individual aged <30 years and nine (18.4%) aged ≥30 years. CBCT allows accurate evaluation of complex root canal morphologies and is useful for endodontic preoperative assessment. Mandibular incisors have more frequent occurrence of two root canals with aging.