Objective: To evaluate outcomes of palliative surgery for malignant bowel obstruction (MBO) and identify factors associated with postoperative survival. Methods: We retrospectively reviewed 27 patients who underwent palliative surgery for MBO between April 2014 and March 2023. Clinical data including symptom relief, oral intake, discharge status, and overall survival (OS) were analyzed. Results: Median age was 70 years; 23 patients were Stage IV. Primary tumors included colon-rectum (15), stomach (6), pancreas (2), and others (4). Peritoneal dissemination was present in 18 cases. Median preoperative Palliative Prognostic Index (PPI) was 3.0. Postoperative symptom relief was achieved in 96.3%, oral intake in 81.5%, and discharge in 51.9%. Median OS was 118 days. Peritoneal dissemination and oral intake status were significantly associated with OS; sex, age, and PPI were not. Conclusion: Palliative surgery may improve outcomes such as symptom relief, oral intake, discharge to preferred care settings, and survival. These findings support its role in advance care planning and enhancing quality of life in patients with terminal cancer.

Purpose: The proportion of terminally ill cancer patients who were discharged home from a hospice/palliative care unit and subsequently died either at home or in the palliative care unit, whose final place of death was consistent with their intended place of care, remains unclear. This study aimed to clarify the consistency between the preferred and actual place of death. Methods: This study was a supplementary study to a multi-institutional bereavement survey conducted in 2018. Results: Responses were obtained from the bereaved families of 202 patients who died at home and 157 patients who died in a palliative care unit. Among them, 80% of home deaths and 82% of palliative care unit deaths were consistent with the stated end-of-life care preference. Among the 22 cases who preferred to die in a palliative care unit but died at home, the most common reason was the availability of physicians and nurses who could provide end-of-life care at home. Among the 11 cases who preferred to die at home but the patients died in a palliative care unit, the most common reason was insufficient pain management at home. Conclusion: Approximately 80% of patients died by their end-of-life care preference, suggesting that many were able to die in their preferred location.

The aim of this study is to clarify the outcomes of blood culture tests in patients with advanced cancer receiving hospice care. A total of 527 patients who took blood culture tests between April 2021 and March 2024 at our palliative care unit were included in the study. The rate of multiple blood culture set collection, positivity rate and contamination rate were 73.4%, 22.5% and 2.6%, respectively. The most-frequently-isolated pathogen was coagulase-negative staphylococci (28.8%). The rate for antimicrobial-resistant bacteria was 4.5%. Among the positive patients, 79.2% were administered appropriate antimicrobial regimens based on the drug susceptibility tests. The most frequently used antimicrobial as targeted therapy for bacteremia was vancomycin (31.5%). Despite their short lifespans, we conclude that blood culture test can be beneficial for patients receiving palliative care. Further observational studies are required to clarify characteristics of infectious diseases in terminally-ill patients with advanced cancer.

Objective: This study retrospectively examined the practice of chlorpromazine (CPZ) administration for sleep disturbance in a palliative care unit, with particular attention to concomitant use of midazolam (MDZ). Methods: A total of 126 patients were reviewed. Among them, 98 patients who continued CPZ for three days or longer were evaluated for changes in nighttime sleep status using a sleep score and for daytime consciousness level. Results: MDZ was used concomitantly in 99 patients (78.5%). Adverse events related to CPZ were observed in 12 patients (9.5%), mainly oversedation and extrapyramidal symptoms, while no severe circulatory or respiratory suppression was noted. Among the 98 patients who received CPZ continuously for three days or longer, sleep scores showed an improving trend; however, some patients experienced decreased daytime alertness, and the possibility that adverse events were underestimated cannot be excluded. Conclusion: This study was a retrospective, single-center analysis based on medical records and therefore has limitations related to the subjectivity of assessment tools and clinical judgment. Further prospective studies using standardized evaluation scales are required to establish the efficacy and safety of CPZ for sleep disturbance.

We report the design and implementation of generative AI (GenAI) -mediated formative feedback activities in undergraduate medical education, motivated by the rapidly increasing use of GenAI among university students worldwide and growing concerns about AI-generated submissions. This practical report describes an approach in which GenAI provides comments on student-written work, with the aim of supporting self-reflection rather than replacing learner effort. The intervention was introduced in two compulsory courses at a Japanese medical school: Professionalism 1a (first year) and Hygiene (third year) .　At course orientation, students received a brief GenAI literacy session outlining appropriate use, common risks, and explicit prohibitions, including the entry of identifiable information. During early implementation in the first-year course, substantial variation was observed in students' GenAI usage skills. To ensure a more consistent experience, instructors provided standardized prompts for students to use when requesting feedback on their draft reports. Students then submitted both their original drafts and the GenAI-generated feedback. Across both courses, the GenAI comments were generally appropriate and aligned with the intended purposes of the assignments, suggesting that standardized prompts can help scaffold students' formative use of GenAI. At the same time, the experience highlighted important challenges. In particular, ethical guidance regarding sensitive or clinical information will become increasingly essential as students begin to use GenAI in more authentic clinical and experiential settings. Strengthening early curricula that address GenAI literacy, responsible use, and privacy protection will therefore be a critical component of future medical education.

Cognitive apprenticeship and reflective practice are fundamental educational theories supporting postgraduate clinical training. Community hospital rotations provide ideal opportunities to apply these theories. However, community hospitals face challenges in securing educational time due to faculty shortages and heavy clinical workloads, leading to on-the-job training becoming the primary educational approach. Consequently, opportunities for structured instruction and reflection may be limited, potentially hindering the implementation of cognitive apprenticeship and reflective practice. To address this mismatch between educational needs and available resources, we implemented a remote educational conference focused on clinical questions (CQs) arising from residents' clinical experiences. Unlike traditional clinical conferences that focus on determining patient management, this initiative centers on reflective dialogue based on CQs formulated by residents themselves. By integrating experiential learning theory and reflective practice theory and focusing specifically on the latter three steps of cognitive apprenticeship, we successfully constructed an effective educational model for remote learning environments. This practice enables high-quality medical education that transcends geographical constraints and is considered valuable for future community-based medical education.

This report describes the design and implementation of a 90-minute flipped classroom workshop for physician career development. Based on Merrill’s First Principles of Instruction, the “Scientific Approach to Career Success” workshop integrates pre-learning and in-person sessions to foster deep reflection and autonomous career planning. The instructional model employs a five-stage structure -Problem-Centered, Activation, Demonstration, Application, and Integration- designed to enable learners to visualize values, analyze decision-making styles, and evaluate social networks. These activities were developed in alignment with eight career competencies based on the National Career Development Guidelines framework. Participants progressed from building a value-based career vision to formulating a realistic action plan informed by evidence and ethical considerations. The approach emphasizes the role of educators as facilitators, promoting learner autonomy and sustained development beyond the session. This model offers a systematic framework for bridging educational theory and practice, providing a promising approach for integrating structured career support into medical education.

Background: The processes through which healthcare professionals learn interprofessional communication and develop related perceptions remain insufficiently understood.　Methods: Semi-structured interviews were conducted with eight healthcare professionals with over 10 years of experience. Transcripts were analyzed thematically, and changes in learning and perception were examined using the framework of communities of practice.　Results: Four themes emerged regarding learning processes: (1) observing colleagues, (2) engaging in conversations to learn patient care from other professions, (3) collaborating while mutually understanding professional roles, and (4) practicing collaborative care while maintaining professional responsibilities. Regarding perceptions, four themes were identified: (5) tools for accurate information sharing, (6) tools for fostering mutual understanding, (7) tools for enabling teams to achieve common goals, and (8) competencies essential for healthcare professionals.　Conclusion: Findings suggest that as experienced professionals deepen their participation in communities of practice, interprofessional communication evolves through a process of reinterpreting prior experiences and understandings, leading to gradual transformation and reconstruction of learning and perceptions.