Tohoku Medical and Pharmaceutical University, Japan, offers “Early Exposure to Medical Practice” in the first semester for first-year medical students to learn about patient-centered care as well as the real-world conditions and issues faced in community medical practice. Owing to the COVID-19 pandemic during the past two years, we planned and implemented online training, including some disability simulations, which mostly aimed to prevent the spread of infection. The students who completed these training courses reported that the online training had certain advantages over hands-on training ; the two activities implemented were not only effective in preventing infection but also had other benefits that only an online environment could provide. Herein, we report the results and some of the merits of these practices in 2021.

Purpose: General surgeons at regional hospitals should have the primary trauma care skills necessary to treat critically ill trauma patients to withstand transfer. This study was conducted to identify a consensus on primary trauma care skills for general surgeons. Methods: An initial list of acute care surgical skills was compiled, and revised by six trauma experts (acute care surgeons); 33 skills were nominated for inclusion in the Delphi consensus survey. Participants (councilors of the Japanese Society for Acute Care Surgery) were presented with the list of 33 trauma care skills and were asked (using web-based software) to rate how strongly they agreed or disagreed (using a 5-point Likert scale) with the necessity of each skill for a general surgeon. The reliability of consensus was predefined as Cronbach’s α ≥ 0.8, and trauma care skills were considered as primarily required when rated 4 (agree) or 5 (strongly agree) by ≥ 80% participants. Results: There were 117 trauma care specialists contacted to participate in the Delphi consensus survey panel. In the 1st round, 85 specialists participated (response rate: 72.6%). In the 2nd round, 66 specialists participated (response rate: 77.6%). Consensus was achieved after two rounds, reliability using Cronbach’s α was 0.94, and 34 items were identified as primary trauma care skills needed by general surgeons. Conclusion A consensus-based list of trauma care skills required by general surgeons was developed. This list can facilitate the development of a new trauma training course which has been optimized for general surgeons.

We conducted a questionnaire survey involving 270 interns in the year 2011 at the pharmaceutical department of Teikyo University, in order to clarify pre- to post-practical training changes in: 1) the degree of pre-clinical training’s usefulness, 2) desired workplace in the future, 3) degree of satisfaction, 4) confidence degree of practical training, etc. The degree of pre-clinical training’s usefulness exceeded 80% in all training periods. Regarding the desired workplace in the future, a large proportion of students answered that they want to become a pharmacist in a pharmacy or hospital, both before and after their practical training in all training periods. Also, it was estimated that students decide their career with reference to their practical training experience. In terms of the degree of satisfaction with practical training, the proportions of those who answered “Satisfied” or “Somewhat satisfied” were: 95.1% in the 1st, 95.6% in the 2nd, and 86.1% in the 3rd periods. The confidence degree significantly increased after practical training in all periods. Because the confidence degree showed a tendency to be higher before the 3rd period of training compared to the other two periods, it was considered that students’ experience of practical training led to increased confidence degree. Regarding communication abilities, the degrees of before-after confidence degree and pre-clinical training’s usefulness were low, and, hence, it was suggested that pre-clinical training needs to be further improved regarding these areas.

Objective: Several drugs can cause analytical interference in clinical laboratory tests.  To prevent errors in clinical judgment as a result of false data, we investigated the information available on the interference of ethical drugs in these tests.
Methods: We examined the information available by collecting and evaluating information in package insert leaflets, collecting and evaluating clinical data on three drugs (bucillamin, captopril, and epalrestat) which affect clinical laboratory test results, and conducting a questionnaire survey of healthcare workers.
Results: From the information available on package inserts, 227 drugs were identified as having the potential to interfere with the chemical reactions used in clinical laboratory tests.  However, the insert information is not sufficient for use in clinical settings because the frequency rate and causative factors of interference are not stated clearly.  The clinical survey results reveal that 40% of patients taking bucillamine and 20% of patients taking epalrestat tested false-positive for urinary ketones.  According to the questionnaire results, medical technologists were more interested than pharmacists and physicians in how drugs affect clinical laboratory tests.
Conclusion: The information currently available on the interference of drugs in clinical laboratory tests is problematical, and it is therefore necessary to collect more clinical data for the proper interpretation and evaluation of abnormal laboratory values.

The purpose of this study was to compare the thigh muscle oxygenation state of competitive road cyclists and non-cyclists during varied pedaling frequency cycling. Six male college road cyclists (CY group) and five male students (NC group) performed four sets of cycling bouts, consisting of 2 minutes of warm up (60 rpm, 50 watts) followed by 5 minutes of pedaling (150 watts) using an electro-magnetic braked cycle ergometer at 40, 60, 90, and 120 rpm. Oxygenated hemoglobin and/or myoglobin (Oxy-Hb/Mb) and deoxygenated Hb/Mb (Deoxy-Hb/Mb) concentrations in the vastus lateralis were measured by near infrared spatially resolved spectroscopy. The Oxy-Hb/Mb level was significantly higher in the CY group than the NC group. But there was no significant intraction effect of the group and pedaling rate on the Oxy-Hb/Mb level. These results suggest that the changes in muscle oxygenation state according to pedaling cadence do not differ between cyclists and non-cyclists. And though the whole body work efficiency decreased according to increasing pedaling cadence, Oxy-Hb/Mb and Deoxy-Hb/Mb levels in the vastus lateralis remained unchanged up to 90 rpm. However, at 120 rpm, the Oxy-Hb/Mb level decreased remarkably and the Deoxy-Hb/Mb level increased. These results suggest that deoxygenation in the vastus lateralis at 120 rpm was higher than that for lower frequencies. And, conversely, oxygen uptake in the vastus lateralis might have increased steeply at 120 rpm. It may be that the maximum pedaling cadence that would not reduce work efficiency in the vastus lateralis is around 90 rpm.

The purpose of this study was to examine the effect of class walking on lifestyle activity. The subjects were recruited from the community around the university, and volunteered to eight weeks intervention. The intervention groups were 2 different walking program groups that included a class-walking group (A : n=32) and a voluntary walking group (B : n=31) ; and the control was a blood-pressure monitor group (C : n=22) . Only A group participated in a walking class with group instruction. Physical activity was measured by pedometer counts before the start of the intervention, during the 8-week intervention and again as follow up four months afterwards. In A group, the number of pedometer counts, during the group walking activity of the 5 th and 6 th weeks, was measured in order to evaluate the number of voluntary steps on the class-walking day. Although there was no significant difference among the three groups in daily activity before the intervention, the activity of A group (12367±3290) and B group (9988±3461) was significantly increased during the intervention. Also, there were significant differences between A and B, A and C. As for A group, the number of steps due to group walking (9025±584 steps) enhanced the daily activity on the class-walking days (16191±3988 steps), but significantly attenuated the voluntary steps on the class-walking days (7166±3988 steps), which did not significantly differ from the baseline of the daily activity. The number of steps on the non-class walking days (i. e. steps other than those taken on the class-walking day ; 11719±3454 steps) was not significantly different than that of B. There was significant enhancement of daily activity 4 months after the intervention for A (11487±4057) and B (9564±2545 steps), but not for C (9070±3485 steps), compared to the baseline. There was not a significant difference between the daily activity of A and B after the intervention. These data suggest that the instruction given and the steps taken in class walking enhance daily activity during the intervention period, and that voluntary steps play a more important role in whether or not one remains active and adheres to regular exercise.

The purpose of this study was to examine the effect of fructose ingestion on maximal exercise performance capacity following prolonged steady-state exercise compared with glucose or placebo ingestion, in 7 male college students (age 23.3±0.7 yr, height 171.3±1.9 cm, weight 68.4±1.4 kg, Vo2max 3.5±0.2 L/min, mean ± SEM) . The subjects cycled constantly on an ergometer at 59± 2 % Vo2max for 100 min divided in the middle by a 5-min rest, and then performed 10 min of all-out self-paced cycling. They ingested either 8 % fructose solution (F), 8 % glucose solution (G) or artifi-cially sweetened placebo (P) before and during exercise (at 20, 40, 65, 85 mm) . Before exercise and at 50 and 100 min of exercise and 5 min after the performance ride, blood samples were collected for determination of the concentrations of blood lactate, serum glucose and serum FFA. In the G trial, the serum FFA level was significantly lower than in the P and F trials at any of the time points dur-ing and after exercise (vs. P ; p<0.01, vs. F ; p<0.05) . However, glucose ingestion maintained serum glucose at a significantly higher level during and after exercise than placebo ingestion (p< 0.01) and improved the total work output in the 10-min performance ride (G vs. P ; 135± 8 KJ vs. 128± 8 KJ, p<0.05) . Although in the F trial, the serum FFA level was elevated during exercise compared to that in the G trial and the serum glucose level was significantly higher than in the P trial (vs. P ; p<0.01), the blood lactate level after exercise was lower than in the G trial and total work output was similar to that in the P trial (123± 8 KJ, vs. G ; p<0.01) . These results indicate that fructose ingestion before and during exercise cannot improve the ability to perform high-intensity exercise late in prolonged exercise despite maintaining the serum glucose level.

The purpose of this study was to compare the effect between cyclists and noncyclists of pedal rates on ankle, knee, and hip joint torque during pedaling exercises. Six male cyclists (CY) and seven male noncyclists (NC) pedaled at 40, 60, 90 and 120 rpm with a power output of 200 W. The lower limb was modeled as three rigid segment links constrained to plane motion. Based on the Newton-Euler method, the equation for each segment was constructed and solved on a computer using pedal force, pedal, crank, and lower limb position data to calculate torque at the ankle, knee, and hip joints. The average planter flexor torque decreased with increasing pedal rates in both groups. The average knee extensor torque for CY decreased up to 90 rpm, and then leveled off at 120 rpm. These results were similar to NC. The average knee flexor torque in both groups remained steady over all pedal rates. The average hip extensor torque for CY decreased significantly up to 90 rpm where it showed the lowest value, but increased at 120 rpm. For NC, the average hip extensor torque did not decrease at 90 rpm compared with 60 rpm, and was significantly higher than CY at 120 rpm (CY : 28.1 ± 9.0 Nm, NC : 38.6 ± 6.7 Nm, p<0.05) . The average hip flexsor torque for NC at 120 rpm increased significanly from 90 rpm, and was significantly higher than CY (CY : 11.6±2.9 Nm, NC : 22.6±11.8 Nm, p<0.05) . These results suggest that it would be better for cyclists to select a pedal rate of between 90 to 110 rpm to minimize joint torque, and, as a result, reduce peripheral muscle fatigue.