Purpose: We identified the risk factors for remnant gastric cancer (RGC) based on remnant gastric mucosal characteristics and gastritis morphology in patients undergoing distal gastrectomy. Materials and Methods: This multicenter retrospective study included 100 patients with RGC after distal gastrectomy and 550 patients without RGC treated between 2013 and 2020.Endoscopic findings, including anastomotic redness, red streaks, enlarged folds, bile reflux as anastomotic findings, as well as disappearance of the regular arrangement of collecting venules (RAC), atrophic gastritis, and intestinal metaplasia as background gastric mucosal findings, were evaluated. Disease risk score matching (1:1) was adjusted for baseline characteristics. Logistic regression analysis was used to develop a risk score model to stratify RGC risk into low, moderate, and high categories. Results: After matching, 96 patients with RGC and 96 controls were analyzed. Anastomotic redness and red streaks, as well as the disappearance of RAC and atrophic gastritis, were significantly more frequent in the RGC group than in the control group, whereas enlarged folds and bile reflux showed no significant differences. Risk scores were assigned as follows:anastomotic redness, 2; red streaks, 3; disappearance of RAC, 7; and atrophic gastritis, 3. The total score stratified patients into high (≥15), moderate (7–14), and low risk (≤6). The positive and negative predictive values were 67.7% and 83.3%, respectively. Conclusions The endoscopic findings of anastomotic redness, red streaks, RAC disappearance, and atrophic gastritis were significantly associated with RGC development.The proposed risk-scoring model could serve as a stratification tool for RGC surveillance.

In this revision, we have attempted to align the Model Core Curriculum for Medical Education competency, "problem-solving ability based on specialized knowledge," with the "Standards of National Examination for Medical Practitioners." The major diseases and syndromes in "Essential Fundamentals" correspond to the basic diseases in Table 1 of the Core Curriculum, symptoms, physical and laboratory examinations, and treatment in "General Medicine" correspond to the items in Table 2 of the Core Curriculum, and the diseases in "Medical Theory" correspond to the diseases in PS-02 of the Core Curriculum. The validity of the diseases in the Core Curriculum was verified using the evaluation results of the examination level classification of the "Research for Revision of National Examination Criteria." Approximately 690 diseases were conclusively selected. This revision mentions the number of diseases in the Core Curriculum for the first time. Hopefully, this will lead to a deeper examination of diseases that should be studied in medical schools in the future.

Following the revision of the structure and content of the Model Core Curriculum for Medical Education to be more outcome-based and the legal status of the medical practice performed by medical students in the clinical clerkship, we have revised the Guideline for Participatory Clinical Clerkship. The following items were revised or newly described : significance of enhancing the participatory clinical clerkship, scope of medical practice, confidentiality, patient consent, patient consultation and support service, objectives of the clinical clerkship, simulation education, departments where the clinical clerkship is conducted, assessment in the clinical practice setting, CC-EPOC, and entrustable professional activities. A foundation has been established to promote seamless undergraduate and postgraduate medical education. However, future work is needed to examine the specific level of performance expected at the end of the clinical clerkship and department-specific clinical practice goals and educational strategies.

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.

Introduction: This study evaluated the effectiveness of co-management of the neurosurgery department by general physicians.Methods: A retrospective observational study was conducted in a tertiary hospital. Length of stay, in-hospital mortality, number of transfers to the intensive care unit (ICU) due to emergency medical problems, prescription sharing ratio with neurosurgeon, and impression reported by nurses were evaluated by comparing one year before and after the co-management of the neurosurgery department was initiated.Results: Length of stay (Median 14 days, 14 days), mortality rate (7.58%, 5.75%) and transfer rate for ICU (3.23%, 1.94%) were not significantly different between one year before and one year after, respectively. Subgroup analysis of patients over 70 years of age hospitalized for cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage showed that the number of patients transferred to the ICU due to medical problems associated with internal medicine significantly decreased (P = 0.04). A general physician was responsible for half of the prescriptions. The nurse's report was highly positive.Conclusion: Co-management of the neurosurgery department by general physicians did not have a significant effect on reducing length of stay or mortality rate; however, we found a decrease in the number of patients transferred to the ICU due to medical problems among elderly stroke patients.

We have conducted a nationwide survey on faculty development for simulation-based medical education in Japan. The response rate was 90%. Forty-seven (68%) schools have implemented faculty development programs for simulation-based education. The most commonly implemented contents were standardized patient development, task trainer, high fidelity manikin operation, and student evaluation, which were related to objective structured clinical examination objective clinical skill assessment. Only 15 percent of medical schools implemented topics on reflective practice, and scientific writing. A constraint on faculty time was the most commonly perceived barrier to simulation use (mentioned by 62 schools; 90%).

Recently, the problem of the high incidence of throwing injuries in young people has been gaining attention. Identifying high-risk players before the onset of the throwing injury is important for prevention. One of the most widely used screening tests for sports-related injuries is the Functional Movement Screen (FMS), which assesses the quality of movement; however, its correlation with throwing injuries has not been established. The purpose of this study was to investigate the correlation between the FMS score and throwing injuries. The FMS was used during the medical check for two hundred and thirty junior high school baseball players. We allotted those who had experienced throwing injuries multiple times to the injury group and those who had never experienced throwing injury to the control group. We then calculated the FMS cutoff value using the receiver operating characteristic curve. In addition, we investigated differences in the incidence of throwing injury between above and below the cutoff value using chi-square test. The FMS cutoff score was 17. Players who scored ≤17 had a significantly higher incidence of throwing injuries than those who scored ≥18. Conclusion: We believe that FMS score is correlated to throwing injuries. In addition, the results suggest that throwing injuries might be prevented in junior high school baseball players who scored ≤17 on the FMS if they undergo training in the correct movement patterns.

Abstract:

 This study examined the ability of medical students to self-assess basic clinical competence and learning strategies including simulation-based medical education for sixth-year medical students (n=903) at nine universities in Japan. About 40% of 27 procedures to achieve clinical skills in a model curriculum were taught using simulators with or without clinical training in hospitals. We noted that significant numbers of procedures were not practiced through any learning strategies. Higher self-assessment scores were observed among students in 4 schools who had more frequent learning opportunities through simulation-based education than among those with less frequent opportunities in 5 schools.

Surgical procedures for atlantoaxial (C1–C2) fusion in young children are relatively uncommon. The purpose of this study was to report on a surgical treatment for a case of atlantoaxial instability caused by os-odontoideum in association with quadriparesis and respiratory paralysis in a 5-year-old girl. We present the patient's history, physical examination, and radiographic findings, describe the surgical treatment and a five year follow-up, and provide a literature review. The instability was treated by halo immobilization, followed by C1–C2 transarticular screw fixation using a computed tomography-based navigation system. At the five year follow-up, the patient had made a complete recovery with solid union. The authors conclude that C1–2 transarticular screw fixation is technically possible as in a case of atlantoaxial instability in a five-year-old child.
Child* ; Child, Preschool* ; Female ; Follow-Up Studies ; Humans ; Immobilization ; Physical Examination ; Quadriplegia ; Respiratory Paralysis