We are under pressure to reform the social security system and work styles. To realize these reforms and basic principles, we need to understand the current environment surrounding the hospital and consider future measures. We report on the problems identified as a result of our investigation of the medical environment in the South West Mikawa West Medical Region and our hospital, and propose the use of emergency medical technicians (EMTs) as a solution to these problems. We examined data from the National Census, the Japan Medical Association Research Institute for General Policy Studies, the Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications, and our hospital’s management meeting. In this medical area the population aged 65 years or older and the demand for medical care are projected to increase toward the year 2045. On the other hand, the number of physicians and nurses per 100,000 population in this medical region is below the national average. Almost no change was seen in the number of patients coming to the hospital by ambulance or the number of emergency admissions by ambulance, and their admission rates did not change significantly over the past 5-year period. However, the rate of unfilled ambulance demand increased, due to the impact of full beds. Of the total number of emergency ambulance admissions, the rate of moderately ill patients averaged 74% over the 5-year period. The number of inpatient transfers in 2022 decreased by 25.5% (176) compared to that in 2019 due to the lack of personnel to transport patients. As the demand for medical care increases toward 2045, we need to reduce the rate of unfilled ambulance demand while at the same time reforming work styles to create a more comfortable workplace for healthcare workers. To achieve these goals, key tasks may be to review the transfer transport system for moderately ill patients and to expand the role of EMTs.

Objective: Checkpoint inhibitor-associated autoimmune diabetes mellitus (CIADM), a variant of type 1 diabetes, is a rare immune-related adverse events (irAEs) caused by antibody-based immune checkpoint inhibitors. CIADM typically manifests as fulminant or acute-onset type 1 diabetes in the insulin-depleted state. However, we encountered a patient with slow-onset CIADM who initially presented with hyperglycemia without decreased insulin secretion after treatment with durvalumab (an anti-PD-L1 antibody).Patient: A 60-year-old man diagnosed with small-cell lung cancer on durvalumab combined with dexamethasone treatment experienced an increase in glycated hemoglobin (HbA1c) from 6.4% to 7.8% after three cycles.Results: Despite preserved endogenous insulin secretion (C-peptide, 2.47 ng/mL with a casual plasma glucose level of 287 mg/dL), basal insulin therapy was initiated considering CIADM. HbA1c levels remained stable (8.5–9.2%) for 3 months but increased to 13.4% at 18 weeks, indicative of CIADM. Declining endogenous insulin secretion resulted in ketosis; however, hyperglycemic crisis was prevented through basal insulin therapy.Conclusion: We emphasize that CIADM develops gradually and does not always occur in the course of fulminant or acute-onset type 1 diabetes; therefore, early initiation of insulin in the presence of hyperglycemia is crucial to prevent hyperglycemic crises.

Following the Japan-Korea Symposium at the 37th ICMART World Congress in Jeju, Korea, September 27-29, 2024, another international symposium was held in Daegu on November 17, 2024, by three countries, including not only Japan and Korea but also the Chinese Medical Association of Acupuncture in Taiwan. In addition, a Korean domestic symposium was held by three societies under the Society of Korean Medicine.　Korea has been actively inviting such international symposiums in recent years, and international exchanges in the field of acupuncture and moxibustion has been progressing further than ever before. Academia of traditional medicine in Japan needs to respond actively to this trend, including human resource development.

Case reports are an indispensable research format in the advancement of medicine. They play a significant role in accumulating medical knowledge on new or rare diseases and evaluating the efficacy and safety of therapeutic interventions. Furthermore, case reports provide a critical opportunity for generating new research hypotheses and are widely recognized for their value as essential educational tools for healthcare professionals. However, some case reports fail to include sufficient essential information, and their incompleteness or lack of transparency may lead to misinterpretation by readers. To address these issues, the CARE (CAse REport) guidelines were established in 2013, providing standards to improve the completeness and transparency of case reports. The CARE guidelines comprehensively cover essential reporting items for case reports in various fields. By adhering to these guidelines, authors can ensure the completeness of information and achieve transparent reporting. However, there still does not seem to be sufficient recognition and dissemination of the CARE guidelines in Japan. Therefore, this article introduces the key components of the CARE guidelines and discusses their application, particularly in the field of acupuncture practice. It is hoped that the wider use of the CARE guidelines in case reports related to acupuncture will enhance reporting quality and facilitate the provision of more reliable and credible information.

Objective: The package inserts of over-the-counter (OTC) drugs may contain yojokun (precepts for health care) that are helpful for preventing illnesses and improving symptoms. However, it is unclear whether yojokun actually catch the attention of users and serve as a useful information resource for self-medication. With the aim of contributing to the promotion of self-medication, this study investigated the status of yojokun inclusion in package inserts and the level of awareness among users, and considered the future utilization of yojokun. Methods: The package inserts of OTC drugs listed on the website of the Pharmaceuticals and Medical Devices Agency were searched by pharmacological classification, and the inclusion of yojokun was checked. Additionally, questionnaire surveys of OTC drug purchasers, pharmacists/registered sellers, and OTC drug sales companies were conducted.Results: Of the 7,508 OTC drugs surveyed, 654 (8.7%) had yojokun listed in the package insert. The contents included a concise, bulleted list of tips for daily living to prevent symptoms from worsening and to heal quickly, with illustrations and other information. The awareness rate of yojokun was 22.0% among OTC drug purchasers and 38.8% among pharmacists/registered sellers, and 91.4% of pharmacists/registered sellers answered that yojokun are useful for self-medication. Regarding sales companies, 61.5% stated that they would like to include yojokun in package inserts, but they lacked the ability to prepare evidence-based yojokun and secure space for them in the package inserts. Conclusion: For OTC drug users, yojokun provide useful information to promote appropriate self-medication. However, the awareness of OTC drug users and pharmacists/registered sellers is low, and the information is not fully utilized. In the future, it will be necessary to further disseminate yojokun and establish a system for providing standardized yojokun.