Background: Few studies have focused on the current state of referral and consultation practice between generalists and specialists at Japanese university hospitals.Methods: We retrospectively analyzed the electronic medical records of 513 outpatients (a cumulative total of 608 patients) who visited the Department of General Medicine of Toyama University Hospital between January and December 2016. All patients used our in-hospital consultation and referral service.Results: We referred 492 new patients to different specialists, with 40% referred to psychiatry, orthopedics, otolaryngology, and dermatology specialists. Our suspected diagnoses were correct for 285 of 395 patients (72%) who were referred to specialists to confirm the diagnosis. No abnormalities were observed in 86 patients (21%), and inappropriate referrals were made for 5 patients (1.2%). We also received 116 consultations from specialists, 66% of which were from orthopedics, psychiatry, gynecology, oral dental surgery, and neurosurgery specialists. Many of the referred patients had vague symptoms such as fever and general fatigue.Conclusion: Improving the practical skills of generalists regarding orthopedic and otolaryngologic problems may result in more appropriate referrals. Our department also served as a consultant for medical problems for specialists, especially orthopedic surgeons and psychiatrists.

A questionaire was sent to school nurses in rural districts of Shimane Prefecture asking them about the problems in the school health education and the school health guidance.
The quantitative and qualitative improvement of the working conditions of school health nurses, and the effective co-operation between domestic education and school education based on the understanding of the changes of rural society is needed for the future development of health education. Above all the amplification of the “problem-oriented school health education” in each school is needed to establish a scientific point of view of school children.

A questionnaire was sent to school health nurses in rural districts of Shimane Prefecture asking them about health conditions and emergency accidents of children, problems of the health care, and safety administration in schools.
The health conditions of children in rural districts were almost common with those of children in cities of Japan. It was suggested that the increase of psychosomatic complaints and disorders of children was directly or indirectly affected by the changes of life conditions in households of side-work farmers, the inhumane competition in education and the drastic urbanization of life style.
The cooperative approach to comprehensive health care of children by the participants of school health and community health is urgently needed to promote the health level.

Actual conditions of the health care of school personnel in rural districts of Shimane Prefecture were investigated, concentrating our attention on the structure of diseases, the contents of health examination, factors impeding health, and so forth.
As a result of our investigation we found that the incidence of adult diseases among school personnel is considerably high. Health examinations with complete contents should be practised in the near future.
Further, the establishment of health care system in the work place, the improvement of working conditions considering sufficiently the peculiarity of mental work and of femininity, the independence of school nurses as specialist should be realized on the basis of the understanding of actual problems, which are obtained by examinations of health care conditions at each work place including epidemiological examination.

Problems in the school health care system of children were studied in rural districts of Shimane Prefecture, Japan. Questionaires which were concerned with the policy and the evaluation of school health care, present situation of health examination in schools, and cooperative activities in the field of school health care between schools and communities were sent to school nurses.
Owing to the recent changes of the general life conditions in rural districts, the life style and the health conditions of children in rural districts became somewhat similar to those in cities. Psychological complaints, psychosomatic diseases, school phobia, obesity and adult diseases such as peptic duodenal ulcer became common in many schools in rural districts.
An inadequate understanding about school health care in teachers and in families, lack of specialists and school nurses in school health care system, few epidemiological studies on the health conditions of children, and the insufficient cooperative activities among schools, families and communities were revealed as important problems to be solved. The scientific health education in schools, adequate health counselling system and the complete health care should be established on the basis of actual living conditions of children and cooperation between school health care and community health care.

We participated in TIPS-FM (Toronto International Program to Strengthen Family Medicine and Primary Care) for two weeks in Toronto in June 2019. This program enabled us to learn many important factors for developing family medicine. Based on Canadian family medicine, which has a long history, we were able to review the missions of family medicine in Japan, and gained further insight into multilayered essentials on the patient-, community-, and global-levels.

Purpose: We report a case of delirium and convulsion after administration of olanzapine in a cancer patient with refractory vomiting. Case report: The patient was a male in his 70s who suffered from lung cancer. After chemotherapy, olanzapine was used for refractory nausea and vomiting. Since this treatment, the patient has experienced delirium and convulsions. While we modified some reversible causes of the delirium, the delirium did not improve. Discontinuation of olanzapine resulted in improvement of the delirium. Recurrent convulsions did not occur with sodium valproate. Olanzapine might increase the risk of delirium and convulsions.