Objective: To clarify the characteristics of medical students' motives for choosing their profession.Methods: A nationwide, cross-sectional, quantitative web survey was conducted using the Profession Choice Motivation Scale for Education Students. Results: Valid responses were obtained from 1,804 medical students, and the applicability of this scale was demonstrated. Medical students considered "contribution to others," "fulfillment in the profession and studying medicine," "financial aspects," and "evaluation by others" to be important, while "mental and physical comfort" was deemed less important. Mean scores for "contribution to others" were significantly higher among female students, public medical school students, students attending their first- or second-choice medical schools, regional quota students, public high school graduates, and first-generation college students. Conversely, students with very low scores for "contribution to others" showed opposite demographic backgrounds. Discussion: The Profession Choice Motivation Scale for Education Students was applicable to the analysis of medical students, and a correlation was observed between demographic backgrounds and profession choice motives.

Objective: Of the total number of prescriptions received, the percentage of refill prescriptions in May-June 2022 was 0.053%. In order to speculate on the reasons for the low utilization rate of the refill system and future developments, we surveyed patients who have been receiving continuous drug treatment for more than 6 months to determine their attitudes toward the refill system.Methods: The survey was conducted on the Web and valid responses were obtained from 290 respondents.Results: The respondents were 44.8% male and 55.2% female, with a mean age of 45.6 ± 10.5 years. Respondents' diseases included hypertension (32.1%), dyslipidemia (15.9%), diabetes (15.2%), psychiatric diseases (10.0%), skin diseases (9.3%), and others. Of the respondents, 83.4% had no prescription change within 6 months, and 69.0% had access to treatment medications for the purpose of going to the hospital, indicating that their symptoms were stable and they could use the refill system. In addition, we found that only 17.2% were aware of the refill system. However, 73.4% of respondents indicated their intention to use the refill system in the future. Therefore, our results strongly suggest that the reason for the lack of its use is due to a lack of awareness of it.Conclusion: It is expected that the refill system will be promoted in the future through awareness-raising events and education of the public. It is thought that the use of the refill system may cause delays in the detection of adverse drug reactions and the overlooking of worsening health conditions. The issue is whether pharmacists can appropriately judge whether or not to continue refill prescriptions.

Objective: To determine the socio-economic and educational backgrounds of first-generation college students (FGCs) among Japanese medical students, with the aim of contributing to the improvement of medical school admissions.　Methods: A nationwide cross-sectional online questionnaire survey was conducted. A total of 1,849 medical students and 295 nursing students participated.　Results: The proportion of FGCs among medical students was 12.1%, lower than that among nursing students (39.4%). The backgrounds of FGCs were compared with those of non-FGCs (students whose parents were university graduates). FGCs were more likely to come from small cities and from outside the Kanto/Kansai regions. They reported lower annual family incomes and had fewer doctors or dentists among their relatives. FGCs attended cram schools less frequently, were more likely to have graduated from national or public high schools, and had higher academic grades. They applied exclusively to national or public medical schools, were more likely to take regional quota or recommended AO entrance examinations, passed these exams immediately after high school graduation, and were more often enrolled in their first-choice and national or public medical schools. FGCs also expressed a stronger intention to work in less-populated areas in the future.　Discussion: The backgrounds of FGCs differ significantly from those of non-FGCs. Further investigation into the challenges and potential of FGCs in medicine is warranted.

OBJECTIVE: To examine the socioeconomic backgrounds of medical students who intend to practice in less-populated areas.METHODS: A nationwide online questionnaire survey was conducted among 1,822 Japanese medical students (1,024 from public universities and 798 from private universities) across 40 medical schools.RESULTS: Regarding preferred future practice locations, 25.2% of students intended to work in areas with populations over 1,000,000; 36.8% in areas with 200,000-1,000,000; 17.2% in areas with 50,000-200,000; and 4.8% in areas with fewer than 50,000 residents. Students who intended to work in less-populated areas (population >200,000) were more likely to have grown up in such areas, come from families with lower annual incomes, have fewer physician parents, have graduated from public high schools, and be enrolled in regional quota programs. Logistic regression analysis identified having a family background in a less-populated area (OR 9.46) and enrollment in a regional quota program (OR 2.72) as significant predictors of the intention to work in less-populated areas.DISCUSSION: There is a correlation between medical students’ intentions to work in less-populated areas and their socioeconomic backgrounds, which are important factors to consider when addressing the uneven distribution of physicians in Japan.

The role of manipulation under anesthesia (MUA) without arthroscopic capsular release in patients with preoperative stiffness undergoing arthroscopic rotator cuff repair (ARCR) remains unclear. Additionally, the association between shoulder stiffness and tendon healing after ARCR is still controversial. This study aimed to compare the clinical outcomes and retear rates between patients with preoperative stiffness treated by MUA alone and those without stiffness. Methods: This retrospective study included 322 patients who underwent ARCR for full-thickness tears between January 2012 and May 2022 with a minimum 2 years of follow-up. Clinical outcomes—including passive range of motion (ROM); the Japanese Orthopedic Association (JOA) score; and the University of California, Los Angeles (UCLA) score—were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were divided into the stiffness group (MUA completed) and the non-stiffness group. Retears were evaluated using magnetic resonance imaging at 6 months postoperatively, and retear rates were analyzed by tear size (medium vs. large/massive). Results: Eighty-eight patients with stiffness and 234 without stiffness met the study inclusion criteria. Preoperative ROM, JOA, and UCLA scores were significantly lower in the stiffness group. Both groups showed significant improvements at final follow-up, with greater gains in the stiffness group. Final outcomes were comparable, except for external rotation. In medium-sized tears, the retear rate was significantly lower in the stiffness group (1.9%) than in the non-stiffness group (10.8%) (P=0.042). No significant difference was observed for large/massive tears. Conclusions: Patients with preoperative stiffness treated with MUA alone achieved comparable outcomes to those without stiffness, with improved tendon healing in medium-sized tears. Level of evidence: III

Objective: Perceptions of citizens and health professions educators towards the socioeconomic backgrounds of medical students were investigated to elucidate the challenges of selecting medical students who will be responsible for the future of healthcare in Japan.Methods: Ten focus groups, comprising 14 citizens and 26 health professions educators, were conducted regarding the presented information on the socioeconomic backgrounds of Japanese medical students. Data were analyzed using an inductive thematic analysis approach.Results: Six themes related to family backgrounds, such as higher economic status, five themes related to social backgrounds, such as social and educational disparity, and four themes related to expectations for medical education, such as selection of medical students with diverse backgrounds were extracted.Discussion: Both citizens and health professions educators were aware of the problem of the skewed socioeconomic backgrounds of medical students and the need to expand diversity. This finding will contribute to the reconsideration of future medical school admission criteria.

As a screening tool for detecting latent pre-locomotive syndrome (latent pre-LS) in women over the age of 40, measuring handgrip strength with a cut-off value of 26 kg was proposed in a previous report. However, this screening method missed 22% of latent pre-LS. It would be beneficial to screen almost persons with latent pre-LS in community pharmacies. In this study, it was investigated whether screening using the combination of measuring handgrip strength and the questionnaire, “Loco-check,” which was proposed by the Japanese Orthopaedic Association, improved the detection of latent pre-LS in the same group mentioned above. Combining only one of the “Loco-check” questions, “I cannot put on a pair of socks while standing on one leg,” with the measurement of handgrip strength with the cut-off value of 26 kg, the detection of latent pre-LS was increased to 90.2%. The odds ratio was 9.72 in logistic regression analysis. Using the combination of the measurement of handgrip strength and the response to one question is both rapid and convenient. Therefore, in this study, this screening combination is proposed to be a useful tool in community pharmacies for detecting early latent pre-LS.

In some molecular targeted therapies, skin disorders including acne-like rashes or maculopapular rashes frequently appear, which are often clinically problematic. In Kampo medicine, it has been reported that the combination of jumihaidokuto and orengedokuto (hereinafter called JHT + OGT) is effective for acne. In this study, we report the experiences of JHT + OGT for the treatment of rashes caused by molecular targeted therapies. We extracted patients from June 2013 to June 2017 who took molecular targeted therapies and the treatment with JHT + OGT for skin rashes. The primary endpoint was severity of rashes before and after treatment by JHT + OGT (judged by CTCAE v4.0). In 22 patients (14 males and 8 females), the rashes after treatment with JHT + OGT significantly improved compared with those before treatment (from the median grade of 2 to 1 [p = 0.011]), with 14 cases of improvement, 6 cases of no change, and 2 cases of deterioration. It was suggested that JHT + OGT for skin rashes caused by molecular targeted therapies could be one of the treatment options.

STUDY DESIGN: Multicenter, prospective study. PURPOSE: To investigate the effects of diabetes mellitus (DM) on surgical outcomes in patients with cervical myelopathy. OVERVIEW OF LITERATURE: To date, few studies have investigated the influence of postoperative blood glucose or glycated hemoglobin (HbA1c) levels on surgical outcomes. METHODS: The participants were patients who underwent surgery for the treatment of cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament. The 61 cases were evaluated preoperatively and 1 year postoperatively using the Japanese Orthopaedic Association (JOA) scores and the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The study variables included fasting blood glucose and HbA1c levels measured preoperatively and at 1 week, 4 weeks, and 1 year postoperatively; the F-wave conduction velocity, latency, rate of occurrence, and M-wave latency in the ulnar and tibial nerves were measured preoperatively and at 1 year postoperatively. The patients were divided into a group without diabetes (N group, 42 patients) and a group with diabetes (DM group, 19 patients). We then assessed the associations between the surgical outcomes and each of the study variables. RESULTS: JOA scores significantly improved in both groups; however, no significant between-group differences were found. There was no significant improvement in the JOACMEQ scores, which assessed cervical function, upper and lower limb function, and bladder function in both groups. We then subdivided the DM group into those with a good control of HbA1c after 1 year (DMG group, 12 patients) and those with HbA1c deterioration after 1 year (DMB group, seven patients), prior to comparing the surgical outcomes. The JOACMEQ scores for upper and lower limb function significantly improved in the DMG group (p<0.01). Compared with the DMB group, there were no significant increases in upper or lower limb function scores in the DMG group. CONCLUSIONS: Poor glycemic control might prevent postoperative functional recovery of the spinal cord.
Asian Continental Ancestry Group ; Blood Glucose ; Diabetes Mellitus ; Electromyography ; Fasting ; Hemoglobin A, Glycosylated ; Humans ; Longitudinal Ligaments ; Lower Extremity ; Neck ; Prospective Studies ; Spinal Cord ; Spinal Cord Compression ; Spinal Cord Diseases ; Tibial Nerve ; Treatment Outcome ; Urinary Bladder

Objective : To investigate whether the frequency of passive motion exercises during the early period after arthroscopic rotator cuff repair affects the range of motion at three months postoperatively. Methods : We retrospectively evaluated 64 patients with rotator cuff tears who underwent arthroscopic repair. Range of motion (ROM) in forward flexion, abduction, external rotation, and internal rotation were assessed preoperatively and at three months postoperatively. Patients were supervised to wear an axillar pillow for six weeks and to commence passive ROM exercise at seven days postoperatively. Passive ROM exercises for 9 hours per week or more were performed in 41 patients (group A), and 3 hours or less of exercises were performed in 23 patients (group B). Results : There were no statistical differences between the two groups in age or gender proportion. The mean differences from preoperative ROM to postoperative ROM were 4° and 17° (group A and B, respectively) in flexion, 5° and 18° in abduction, -14° and -12° in external rotation, and -3 and -2 spinous processes in internal rotation, and there were no differences in all directions between the two groups. Even when subjects were limited to the patients without shoulder contractures preoperatively, there was no difference between the two groups. Conclusion : Early passive motion exercise for long hours after arthroscopic rotator cuff repair did not give a positive effect on early improvement in ROM. Scar formation and adhesion at the subacromial space may influence this outcome.