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.

BACKGROUND: Dental caries is a chronic childhood disease and one of the most prevalent public health problems worldwide. Lead is a heavy metal that is taken up by the teeth and bones. However, the association between lead exposure during pregnancy, when the tooth germs are formed, and the prevalence of dental caries in the primary dentition remains unclear. This study aimed to examine the association between maternal blood lead levels and the prevalence of dental caries in the primary dentition of children. METHODS: This cross-sectional study was conducted as an Adjunct Study to the Japan Environment and Children's Study (JECS), which is an ongoing nationwide birth-cohort study. Among children participating in the JECS at the University of Occupational and Environmental Health Sub-Regional Center, those aged 7-8 years underwent oral examination and questionnaire administration. The dft (i.e., sum of the number of decayed and filled primary teeth) was then determined. The dft numerically expresses the dental caries prevalence in the primary dentition (larger value indicates more prevalent dental caries). Poisson regression analyses with robust standard errors were performed to evaluate the association between maternal blood lead levels during pregnancy, measured using frozen samples, and the dft. RESULTS: The study included 139 children, of whom 54.7% were girls, and 89.2% were 7 years old. The median maternal blood lead level was 6.1 ng/g (25-75 percentile, 5.0-7.3). The median dft was 0 (25-75 percentile, 0-4). After adjusting for covariates including age, sex, and oral health status and behavior, maternal blood lead levels were significantly associated with increased dft (prevalence ratio, 1.6; 95% confidence interval, 1.3-1.8; per one standard deviation increase in natural log-transformed maternal blood lead levels). CONCLUSIONS This study found an association between maternal blood lead levels and the prevalence of dental caries in the primary dentition of children aged 7-8 years. Maternal exposure to lead during mid- to late-term pregnancy may affect the caries susceptibility of children after birth.
Humans ; Lead/blood* ; Female ; Dental Caries/epidemiology* ; Prevalence ; Tooth, Deciduous ; Male ; Japan/epidemiology* ; Child ; Cross-Sectional Studies ; Pregnancy ; Adult ; Maternal Exposure/adverse effects* ; Environmental Pollutants/blood* ; Prenatal Exposure Delayed Effects/epidemiology*

Hot flashes decrease the quality of life and increase the risk of cardiovascular diseases, but there are no established therapies for them. In this report, we describe two cases of hot flashes after hematopoietic stem cell transplantation successfully treated with jiinkokato. Case 1 was a 61-year-old woman with acute myeloid leukemia. She received cord blood transplantation and suffered from hot flashes, hyperhidrosis, and night sweat during tapering of immunosuppressants. She started to take jiinkokato and her symptoms improved immediately. Case 2 was a 51-year-old man with myelodysplastic syndrome. He received bone marrow transplantation, and developed hot flashes during taking bakumondoto and goshajinkigan for dry cough and dysuria. He switched from these Kampo medicines to jiinkokato and his symptoms improved gradually. In both cases the patients had conditions of the pattern of yin deficiency with excessive heat caused by strong cancer chemotherapy, so we considered jiinkokato to be effective for their hot flushes. We believe that jiinkokato may be an option for the treatment of hot flushes associated with hematopoietic stem cell transplantation.

I herein report a case of epidural and subdural hematoma associated with meningeal infiltration of acute leukemia, which was ineffective to platelet transfusion, successfully treated with kamikihito. A 44-year-old woman with mixed phenotype acute leukemia developed left-side facial palsy during bone marrow suppression phase of chemotherapy at first relapse, and was diagnosed as meningeal infiltration. Brain magnetic resonance imaging showed meningeal thickening and epidural and subdural hematoma. The laboratory data showed thrombocytopenia and no remarkable abnormalities in coagulation. She received frequent platelet transfusions, whole-brain irradiation, and intrathecal chemotherapy, with the exacerbation of intracranial hematoma, and whole-brain irradiation and intrathecal chemotherapy had to be discontinued. Intracranial hematoma was improved with additional Kampo therapy with kamikihito in accordance with traditional “sho” indications for the purpose of hemostasis, and restarted intrathecal chemotherapy improved her meningeal infiltration. Finally, she could receive cord blood transplantation because of good control of meningeal infiltration of leukemia and intracranial hematoma. Kampo therapy can be considered one of the treatments for transfusion-ineffective intracranial hematoma.

Abdominal distension is one of the common symptoms and can cause abdominal pain and anorexia, which may raise adverse effect on general well-being and quality of life. In Western medicine, there are specialized treatments for structural lesions associated with abdominal distension, but functional abdominal distension is often difficult to treat. There have been some reports of Kampo medicine for treatment of abdominal distension, but no case reports on tokishigyakukagoshuyushokyoto. We experienced two cases of abdominal distension successfully treated with tokishigyakukagoshuyushokyoto. Case 1 was 86-year-old woman who developed abdominal distension with frequent belching. Case 2 was 59-year-old man who developed abdominal distension associated with opioid. Regulating qi medicine was not effective for abdominal distension in both cases. Both cases had reversal coldness of the extremities, tympanic sounds of abdomen, coldness of abdomen, and inguinal tenderness and resistance. Therefore, we diagnosed them as tokishigyakukagoshuyushokyoto sho. After administration of tokishigyakukagoshuyushokyoto, in Case 1, the frequency of belching decreased and the appetite increased with the improvement of abdominal distension. In Case 2, increasing the dose of goshuyu in tokishigyakukagoshuyushokyoto relieved abdominal distension. Tokishigyakukagoshuyushokyoto can be effective for abdominal distension with interior cold pattern.

Persistent or intractable hiccups worsen the activity of daily life and the quality of life of patients, but are sometimes difficult to treat. There are no recommended therapies in Western medicine for hiccups, and Kampo medicine can often be used. However, there have been no case reports on keishininjinto for hiccups. We experienced two cases of hiccups successfully treated with keishininjinto. Case 1 was a 68-year-old man who continued intractable hiccups for 3 years. Case 2 was an 81-year-old man who developed persistent hiccups during mechanical ventilation. Both cases had spontaneous sweat, tendency of diarrhea, epigastric discomfort and resistance, and cold of epigastrium, so we diagnosed them as keishininjinto-sho. It took 6 months to improve hiccups after administration of keishininjinto in case 1 and 1 week in case 2. Keishininjinto can be effective for hiccups with interior and cold pattern.

We report a case of severe headache associated with cerebellar infarction was successfully treated with Kampo therapy. The patient complained of severe headache and vertigo in spite of standard therapy after the decompression craniectomy. However, his symptoms were relieved immediately by administration of goreisan. The pharmacological effect of Kampo formulation i.e. goreisan is still unknown, but this formulation has been used for headache with edema, vertigo and vomiting. According to the classic textbook, this formulation has a potential to improve water imbalance in the body, including brain edema. This Kampo medicine is seemed to be an alternative to manage such patients.

The authors experienced two cases of trigeminal neuralgia successfully treated by a Kampo formulation tokishigyakukagoshuyushokyoto (TSG). Case 1 is 70-year-old woman who complained of severe pain on the right side of her face. She was administered carbamazepine. It was effective for the facial pain but she could not take it continuously because of side effect, namely ataxia. Therefore, we tried to administer TSG. This Kampo formulation proved effective, and her pain was controlled without carbamazepine. Case 2 is 69-year-old woman who complained of localized pain on the right side of her face. In this case TSG alone was effective.

Although saikanto has often been used for infectious pleuritis, there are few reports on the usefulness of it in recent years. We experienced a patient successfully treated with saikanto, who was suffering from bacterial pleuritis with residual pleural effusion, which was difficult to drain and treat with antibacterial drugs. Kampo treatment including saikanto should be used for pleuritis that is not sufficiently improved by Western medical treatment alone.

Keishininjinto has been used for those who have both interior cold pattern of ninjinto and exterior pattern, but there were no reports on improvement of hypertension. We experienced two cases that treatment with keishininjinto was effective for hypertension. The complaint of one case was dizziness, and the other was diarrhea. Both cases had epigastric discomfort and resistance, cold of epigastrium, and upper heat and lower cold. Treatment with keishininjinto was effective not only for the complaints but also for improvement of hypertension. Hypertension can be managed by Kampo therapy with keishininjinto in accordance with traditional sho indications. We consider that there were interesting clinical cases treated with Kampo medicine based on the theory whereby sho correlates with a formulation.