Radical hysterectomy is a standard surgery to treat early-stage uterine cervical cancer. The Laparoscopic Approach to Cervical Cancer (LACC) trial has shown that patients receiving minimally invasive radical hysterectomy have a poorer prognosis than those receiving open radical hysterectomy; however, the reason for this remains unclear. The LACC trial had 2 concerns: the learning curve and the procedural effects. Appropriate management of the learning curve effect, including surgeons’ skills, is required to correctly interpret the result of surgical randomized controlled trials. Whether the LACC trial managed the learning curve effect remains controversial, based on the surgeons’ inclusion criteria and the distribution of institutions with recurrent cases. An appropriate surgical procedure is also needed, and avoiding intraoperative cancer cell spillage plays an important role during cancer surgery. Cancer cell spillage during minimally invasive surgery to treat cervical cancer is caused by several factors, including 1) exposure of tumor, 2) the use of a uterine manipulator, and 3) direct handling of the uterine cervix. Unfortunately, these issues were not addressed by the LACC trial. We evaluated the results of minimally invasive radical hysterectomy while avoiding cancer cell spillage for early-stage cervical cancer. Our findings show that avoiding cancer cell spillage during minimally invasive radical hysterectomy may ensure an equivalent oncologic outcome, comparable to that of open radical hysterectomy. Therefore, evaluating the importance of avoiding cancer cell spillage during minimally invasive surgery with a better control of the learning curve and procedural effects is needed.

In 2015, Tokyo Medical University launched Medical Professionalism for 2nd, 3rd, and 4th year medical students to study professionalism in a sequential manner. The lecture for the 2nd year students was taught together with a representative of LGBTQ support groups. The lecture for the fourth-year students was taught together with a urologist who was a representative of a transgender support group. In summarizing the reports of the fourth-year students who took the lecture in 2021, many students thought that learning about LGBTQ was necessary from the early grades and wanted a more active learning experience. It is necessary to consider more effective learning by devising class content and methods.

The number of students with disabilities is increasing in healthcare and other fields. However, support systems have yet to progress, and faculty and staff often find it difficult in the field. About 10% of medical students in the United States report that they have a disability, and reasonable accommodation is provided in didactic, lab, and clinical setting. The government and others have indicated support policies for students with disabilities, and a large-scale survey of healthcare providers with disabilities has been conducted, and the issues have been clarified. This section introduces specific examples of support and reasonable accommodation for students with disabilities overseas. It is thought that the training of students with disabilities and their employment will facilitate diversity among healthcare professionals and improve the quality of healthcare. There is an urgent need to understand the overall picture of healthcare students with disabilities in Japan and to develop support systems for their inclusion.

Objectives: This study aimed to explore nurses’ treatment preferences for patients with advanced cancer and investigate the factors affecting these preferences. Methods: Self-administered questionnaires were distributed to nurses at two hospitals who had experience in cancer patient care. Nurses recorded their treatment preferences and nurses’ value considered in their preferences for two vignettes of patients with advanced cancer that differed in performance status (PS) and prognosis. Univariate and multivariate analyses were used in this study. Results: Of 383 nurses, 300 (valid response rate, 78.3%) responded. Multiple regression analyses revealed that regardless of patients’ prognosis or PS, nurses’ treatment preferences were associated with their values regarding respecting patient wishes and the low probability of prolonging survival through treatment. For case with one month survival prognoses, nurses valued avoidance of discomfort, associated with side effects through treatment. Nurses recommended treatment in case with prognoses of 6 months and PS of 1, while they responded with almost same percentages of recommendation of continuing and discontinuing treatment for those with prognoses of 1 month and PS of 3. Conclusions: Nurses’ treatment preferences were associated with nurses’ values. Nurses’ involvement in treatment decision-making processes after sharing goals for patients’ treatment is potentially beneficial.

Objective: This study aimed to investigate self-perceived burden (SPB) on families experienced by patients with cancer undergoing outpatient chemotherapy, and factors that affect SPB. Methods: Self-administered questionnaires were sent to patients with cancer in 17 designated cancer care hospitals. Of 1,981 effective responses (response rate 54.7%), 600 patients with cancer undergoing outpatient chemotherapy were included in this study. Results: More than 85% of participants reported SPB on their families. Multiple logistic regression analyses revealed independent physical and social factors that influenced the SPB on families among patients with cancer undergoing outpatient chemotherapy. Physical factor was recurrent or metastasized. Social factors were 40s or younger; living with families; marital history; worries of work or financial problems; worries of interpersonal relationship with families and others. Discussion and Implications: Our findings suggest that medical staff may need to offer psychological care according to patient’s cancer progression and support according to their social background to reduce SPB on their families.

Introduction: This study aims to reveal the characteristics of patients' narrative videos and discuss the usability of video interviews with healthcare students.Methods: One hundred six medical students and 92 nursing students participated in this study. They watched an interview video of a breast cancer patient in class and wrote a description of their impressions. Student responses related to the interview video were qualitatively analyzed using Step for Coding And Theorization (SCAT).Results: The categories that emerged from the analyzed data were "useful for healthcare professionals to know about patients' feelings" , "useful for patients with the same diseases" , "the patient's own voice was realistic" , and "want to use before clinical training" .Discussion: The interview video was thought to be useful for students as it allowed them to feel the realism of the patients' narrative. The interview video was also convenient for lectures. For these reasons, it was concluded that interview videos of patients' narratives could be a useful educational material for healthcare students.

OBJECTIVE: Family and twin studies have suggested genetic liability for panic disorder (PD) and therefore we sought to determine the role of noradrenergic and serotonergic candidate genes for susceptibility for PD in a Japanese population. METHODS: In this age- and gender-matched case-control study involving 119 PD patients and 119 healthy controls, we examined the genotype distributions and allele frequencies of the serotonin transporter gene linked polymorphic region (5-HTTLPR), −1019C/G (rs6295) promoter polymorphism of the serotonin receptor 1A (5-HT1A), and catechol-O-methyltransferase (COMT) gene polymorphism (rs4680) and their association with PD. RESULTS: No significant differences were evident in the allele frequencies or genotype distributions of the COMT (rs4680), 5-HTTLPR polymorphisms or the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients and controls. Although there were no significant associations of these polymorphisms with in subgroups of PD patients differentiated by gender or in subgroup comorbid with agoraphobia (AP), significant difference was observed in genotype distributions of the −1019C/G (rs6295) promoter polymorphism of 5-HT1A between PD patients without AP and controls (p=0.047). CONCLUSION: In this association study, the 1019C/G (rs6295) promoter polymorphism of the 5-HT1A receptor G/G genotype was associated with PD without AP in a Japanese population.
Agoraphobia ; Asian Continental Ancestry Group ; Case-Control Studies ; Catechol O-Methyltransferase* ; Gene Frequency ; Genotype ; Humans ; Panic Disorder* ; Panic* ; Polymorphism, Genetic* ; Receptor, Serotonin, 5-HT1A* ; Serotonin Plasma Membrane Transport Proteins ; Serotonin*

OBJECTIVE: In this study, we investigated the determinants of remission and discontinuation of paroxetine pharmacotherapy in outpatients with panic disorder (PD). METHODS: Subjects were 79 outpatients diagnosed with PD who took 10–40 mg/day of paroxetine for 12 months. The candidate therapeutic determinants included the serotonin transporter gene-linked polymorphic region and the −1019C/G promoter polymorphism of the serotonin receptor 1A as genetic factors, educational background and marital status as environmental factors, and early improvement (EI) at 2 weeks as a clinical factor were assessed. The Clinical Global Impression scale was used to assess the therapeutic effects of the pharmacotherapy. RESULTS: Cox proportional hazards regression was performed to investigate the significant predictive factors of remission and discontinuation. EI was only a significant predictive factor of remission. EI was a significant predictive factor of remission (hazard ratio [HR], 2.709; 95% confidence interval [CI], 1.177–6.235). Otherwise, EI and marital status were significant predictive factors of the discontinuation. EI (HR, 0.266; 95% CI, 0.115–0.617) and being married (HR, 0.437; 95% CI, 0.204–0.939) were considered to reduce the risk of treatment discontinuation. In married subjects, EI was a significant predictive factor of the discontinuation (HR, 0.160; 95% CI, 0.045–0.565). However, in unmarried subjects, EI was not a significantly predictive factor for the discontinuation. CONCLUSION: EI achievement appears to be a determinant of PD remission in paroxetine treatment. In married PD patients, EI achievement also appears to reduce a risk of discontinuation of paroxetine treatment.
Drug Therapy ; Humans ; Marital Status ; Marriage* ; Outpatients* ; Panic Disorder* ; Panic* ; Paroxetine* ; Patient Dropouts ; Remission Induction ; Serotonin ; Serotonin Plasma Membrane Transport Proteins ; Single Person ; Therapeutic Uses ; Treatment Outcome*

The concept of sexual minority contains lesbian, gay, bisexual, transgender (LGBT) and disorders of sex development. Despite many recent advances in rights for sexual minorities in the world, bias against them still exit. We held a workshop ‘toward better care for sexual minorities' on the 6th Annual Conference of Japan Primary Care Association 2015. Four lecturers talked about health disparities among sexual minority patients. We want this paper help reducing the readers' prejudice towards the sexual minorities and thus impact their future clinical practice.

Objectives: The aim of this study was to explore the first-year medical students’ perception of their learning from a lecture about sexual minorities.
Methods: In September 2012, a physician and a gynecologist first lectured about sex differences, reproductive medicine, and sexually transmitted infections. Next, the representative of a support group for a sexual minority talked about the prejudice and discrimination toward sexual minorities. He showed a video about a high school student who had publicity revealed his sexual orientation. We analyzed the students’ reports by the qualitative data analysis method Step Coding and Theorization. The students’ descriptions were extracted, coded by contents, and then grouped into several categories.
Results: Many students were surprised at the percentage of persons belonging to a sexual minority. By watching the DVD they came to realize that homosexuals are just like other persons in most ways. They mentioned the need for correct knowledge about sexual minorities.
Conclusion: We believe that the educational session about sexual minorities is meaningful for and valued by medical students, and medical care for sexual minorities should be taught to medical students.