A certain period of time has passed since the transition to the General Medicine residency system under the Japanese Medical Specialty Board and Family Medicine specialist training system by the Japan Primary Care Association. We have summarized the needs of residents identified in the survey, and detailed the activities to date and prospects of the Japanese Association of Family Physician Trainees, a self-help support organization, which is an official subcommittee of the Japan Primary Care Association, from the viewpoint of the residents. We believe that this paper will serve as a resource for the training of residents, help guide them under the new system, and help to improve the training system, considering evidence suggesting that information may not be reaching residents who need support.

Saffron (Crocus sativus L.) is classified as a beneficial herb in the treatment of “Oketsu,” eliminating blood stagnation. The clinical symptoms of “Oketsu” include feeling cold and arthralgia. The pathological condition of “Oketsu” is considered to be increased blood viscosity and microvascular disorders.However, no useful biomarker has been reported for evaluation of the degree of “Oketsu.” Here, we investigated the clinical effect of saffron on the symptoms of “Oketsu” in patients with autoimmune diseases. At the same time, we measured the plasma levels of platelet factor 4 (PF-4) and beta-thromboglobulin (β-TG) as platelet activation markers. Seventy-one patients (66 women and 5 men, mean age 52.3 ± 16.1) were studied. They were administered saffron (300mg∼900mg) with traditional Kampo medicine. The clinical symptoms of “Oketsu” improved (80.9%, n=38/47) and we measured PF-4 and β-TG in pre-and post-saffron treatment periods. The plasma levels of PF-4 and β-TG significantly decreased after saffron therapy (PF-4 : before 49.6 ± 29.8, after 24.0 ± 19.6ng/ml, β-TG : before 117.5 ± 64.0, after 64.6 ± 47.1ng/ml;paired t-test, p < 0.0001, respectively). These results suggest that saffron is effective in treatment of the symptoms of “Oketsu” in allergy and collagen disease patients. Moreover, PF-4 and β-TG may be useful biomarkers of the degree of “Oketsu.”

Purpose：We investigated the factors associated with medical device-related pressure ulcer (MDRPU) due to lower extremity orthosis in patients undergoing convalescent rehabilitation for stroke.Methods：This retrospective study included patients with stroke who wore ankle foot orthosis in the convalescent rehabilitation ward. We measured the following items at admission：Brunnstrom recovery stage, presence of sensory disturbance, exhibition of unilateral spatial neglect, functional independence measures at admission and discharge, and presence of MDRPU. In the statistical analysis, logistic regression analysis was performed to identify the significant factors associated with MDRPU.Results：Ninety-five participants were enrolled in this study (mean age：54.9 ± 11.6 years, Male：78.9%). In logistic regression analysis, Age (odds ratio＝1.05, 95% confidence interval＝1.01-1.10, p＜0.05) and the presence of sensory disturbance (odds ratio＝5.17, 95% confidence interval＝1.39-19.28, p＜0.05) at admission was extracted as the cause of MDRPU.Conclusion：Sensory disturbance at admission is associated with MDRPU in patients undergoing convalescent rehabilitation for stroke who wear ankle foot orthosis.

Residents have teaching roles in clinical practice, and the importance of these roles has been pointed out. This is due to their proximity to learners as Near-Peers. There are two aspects to consider: cognitive proximity, which allows them to share what learners don’t know, and spatial proximity, which allows us to share time and space for an extended period. Residents-as-teachers programs, which aim to improve teaching skills for residents, are being developed all over the world, but are still rare in Japan. We are conducting research to determine what teaching competencies residents should have. We are running a one-year fellowship based on the results of that research. The scale of the program has gradually increased, and in 2020, due to COVID-19, the fellowship went online. We restructured the fellowship in terms of Study/Workload, Enhancing Engagement, and Technical Issues. We received high satisfaction ratings for the online implementation.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.