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: /Aim: The aim of this study was to compare the therapeutic efficacy of ablation and surgery in solitary hepatocellular carcinoma (HCC) measuring ≤5 cm with a large HCC cohort database. Methods: The study included consecutive 2,067 patients with solitary HCC who were treated with either ablation (n=1,248) or surgery (n=819). Th e patients were divided into three groups based on the tumor size and compared the outcomes of the two therapies using propensity score matching. Results: No significant difference in recurrence-free survival (RFS) or overall survival (OS) was found between surgery and ablation groups for tumors measuring ≤2 cm or >2 cm but ≤3 cm. For tumors measuring >3 cm but ≤5 cm, RFS was significantly better with surgery than with ablation (3.6 and 2.0 years, respectively, P=0.0297). However, no significant difference in OS was found between surgery and ablation in this group (6.7 and 6.0 years, respectively, P=0.668). Conclusion The study suggests that surgery and ablation can be equally used as a treatment for solitary HCC no more than 3 cm in diameter. For HCCs measuring 3-5 cm, the OS was not different between therapies; thus, ablation and less invasive therapy can be considered a treatment option; however, special caution should be taken to prevent recurrence.

The aim of this study is to evaluate the effects of agricultural activity on cognitive function, physical function, motivation, activity of daily living (ADL), self-efficacy and quality of life (QOL) of hospitalized elderly with dementia using multivariate statistical analysis. Elderly with dementia performed them for 2 months that replaced with agricultural activities once a week after they performed ordinary activities for 2 months. Ordinary and agricultural activities showed higher score than control condition. Two therapies are compared by principal component analysis (PCA), correlation analysis and multiple regression analysis (MRA). From the PCA analysis, motivation, muscular strength, walking ability, and mobility ability tended to improve during agricultural activities, but there was no significant difference in cognitive function, daily life, and behavioral disorders. In the correlation analysis, walking speed, walking time, timed up and go test (TUG), and grip strength showed a high score. MRA showed that improved physical function is improved during agricultural activities, but no significant improvement in cognitive function and ADL. Therefore, it was found that agricultural activities may be useful for improving physical functions. Long-term evaluation is needed for discussing the effects on cognitive functions and ADL.

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.

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.

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.