The Ministry of Health and Welfare of Japan is planning a pooling system for multiple-choice questions (MCQs) for the national examination for medical practitioners. To clarify possible problems of such a system, a field study was performed by 10 medical schools in Japan using 90 MCQs from previous examinations. Nine hundred twenty-four 6th-year students participated in the field test. For each MCQ, the correct-response rates at the originating school and those obtained in the field test were significantly correlated. Thus, the correct-response rates to questions on the field test could be predicted from the rates at the originating schools. However, for each question the correct-response rate was significantly higher for students of the originating school than for students of other schools. In the national examination, care should be taken to prevent differences in scores on the basis of question sources.

Edwardsiella tarda causes enterocolitis, which does not need to be treated in many cases. However, in immunocompromised hosts, the disease becomes severe resulting in soft tissue abscess. In such cases, removal of the lesion is required at an early stage. An 83-year-old woman presented to the emergency department with a chief complaint of fever, which was initially treatment as complex urinary tract infection. Further evaluation revealed she had E. tarda sepsis and that the bacteria was highly likely to originate from an abscess of the uterine adnexa. Because we thought a complex surgery was necessary, we transferred her to a regional core hospital. However, she recovered with only administration of antibacterial agents at that hospital.Then, 1 year and 4 months later, she was admitted to our hospital again. We made a diagnosis of disease recurrence. She did not improve with antibacterial therapy this time, so she was transferred to the other regional core hospital and underwent surgery. Histological examination revealed an appendiceal carcinoma in the abscess lesion. This case suggests that when E. tarda bacteremia is diagnosed, its focus and the root cause should be investigated.

Hospital A has 12 dedicated beds for patients with intractable neurological diseases, which are chronic conditions that increase dependence on medical care as they progress. Disease progression also varies by disease and by patient. Patients and their family become more anxious about discharge when they think about how much the patient’s condition has changed since admission. Caregivers must acquire specialized skills due to the patient’s increased dependence on medical care and the increased number of care tasks, and it takes time to master those skills. Discharge is associated with many financial, physical, and mental stressors, and in some cases discharge coordination is difficult and the timing for discharge is missed. We sought to investigate how to provide more efficient discharge support and conducted a case study of 3 patients with intractable neurological diseases. Here we discuss our findings and our creation of a discharge support manual that clarifies when to start discharge coordination, necessary preparations, and topics for counseling patients and caregivers.