Clinical clerkships in medical school requires an educational approach that integrates medical students into the medical team and progressively assigns medical tasks to them based on their competencies. However, it is challenging for supervisors to delegate tasks to medical students gradually while considering medical safety. This paper outlines the design of an emergency department clinical clerkship program based on the Four Component Instructional Design (4C/ID) model. This model enables students to learn complex task performance skills in stages while developing a schema, considering the cognitive load involved in learning complex tasks. The 4C/ID model is anticipated to be an effective instructional design for constructing clinical clerkship programs.

BACKGROUND: The Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study was launched to investigate risk factors for osteoporotic fractures, interactions of osteoporosis with other non-communicable chronic diseases, and effects of fracture on QOL and mortality. METHODS: FORMEN baseline study participants (in 2007 and 2008) included 2012 community-dwelling men (aged 65-93 years) in Nara prefecture, Japan. Clinical follow-up surveys were conducted 5 and 10 years after the baseline survey, and 1539 and 906 men completed them, respectively. Supplemental mail, telephone, and visit surveys were conducted with non-participants to obtain outcome information. Survival and fracture outcomes were determined for 2006 men, with 566 deaths identified and 1233 men remaining in the cohort at 10-year follow-up. COMMENTS The baseline survey covered a wide range of bone health-related indices including bone mineral density, trabecular microarchitecture assessment, vertebral imaging for detecting vertebral fractures, and biochemical markers of bone turnover, as well as comprehensive geriatric assessment items. Follow-up surveys were conducted to obtain outcomes including osteoporotic fracture, cardiovascular diseases, initiation of long-term care, and mortality. A complete list of publications relating to the FORMEN study can be found at https://www.med.kindai.ac.jp/pubheal/FORMEN/Publications.html .
Aged ; Bone Density ; Cardiovascular Diseases/etiology* ; Cohort Studies ; Geriatric Assessment ; Humans ; Independent Living ; Japan/epidemiology* ; Long-Term Care/statistics & numerical data* ; Male ; Middle Aged ; Osteoporosis/etiology* ; Osteoporotic Fractures/etiology* ; Risk Factors

BACKGROUND: Limited evidence exists regarding the relationship between central-to-peripheral fat ratio measured by dual-energy X-ray absorptiometry (DXA) and subsequent cardiometabolic risk in both pediatric and adult populations. METHODS: The present cohort study investigated the relationship between DXA-measured body fat distribution and cardiometabolic parameters. The source population was 275 4th-6th graders (aged 9.6-12.6 years) in the northeast region of Japan (Shiokawa area in Kitakata). A 3-year follow-up was conducted to obtain complete information from 155 normal-weight children (87 boys and 68 girls). Normal-weight children were identified using sex- and age-specific international cut-offs for body mass index (BMI) based on adult BMI values of 25 kg/m and 18.5 kg/m, respectively. Body fat distribution was assessed using the trunk-to-appendicular fat ratio (TAR) and trunk-to-leg fat ratio (TLR) measured by DXA. RESULTS: In boys, systolic blood pressure (SBP) at follow-up showed a significant relationship with TAR at baseline after adjusting for age, height, pubic hair appearance, SBP, and whole body fat at baseline (β = 0.24, P < 0.05), and SBP also showed a significant relationship with TLR after adjusting for confounding factors including whole body fat (β = 0.25, P < 0.05). In girls, there were no significant relationships between blood pressure and TAR/TLR. CONCLUSION Body fat distribution in normal-weight boys predicted subsequent blood pressure levels in adolescence. The relationship between fat distribution and blood pressure was independent of fat volume.
Absorptiometry, Photon ; Adolescent ; Blood Pressure ; Body Fat Distribution ; Child ; Cohort Studies ; Humans ; Japan ; Male

　　It usually takes several days to detect slow-growing bacteria by a blood culture system. Moreover, even if the microbial growths are detected in blood samples, they will escape our notice at a microscopic examination using Gram’s stain. Consequently, the results are often regarded as false positive.　　This paper reports case of malignant lymphoma in which bloodstream infection caused by slow-growing spirillum was observed. The patient in chemotherapy for malignant lymphoma, complained of repeated fever. Repeated blood cultures were taken and occasionally positive signals, which mean increased CO2 concentrations in the culture bottle, were detected by BACTEC 9240 (Becton Dickinson). However, routine microscopic examination with Gram’s stain did not detect any bacteria. Thus, the results of BACTEC were thought to be false positive. Thereafter, the bacterial culture period was extended. Finally, a spirillum, suspected of one of Helicobacter species, was observed microscopically. The detected spirillum was regarded as Helicobacter canadensis with 98.08% homology, using polymerase chain reaction with the 16S rRNA method and basic local alignment search tool (BLAST).　　H. canadensis is one of new species isolated from humans with diarrhea. This bacterium is considered to cause a zoonotic infection. There have been some case reports that this bacterium infected immunosuppressive patients, so we should exercise caution against such conditions. Moreover, we should keep vigilant against the spread of slow-growing bacteria when there are discrepancies in findings between blood culture system and microscopic examination. It is useful to extend the culture period to detect such slow-growing bacteria.

Since the Infection Control Team (ICT) was organized in 1999, our hospital has been engaged in evidence-based operations against nosocomial infections. The ICT's major activities included guidance in preventive measures against infections, surveillance involving continuous environmental monitoring, proposition as regards prescription of antibacterial medicines, and consultation with clinicians about prophylaxis. The team comprising physicians, nurses, pharmacists and clinical laboratory technicians has made expert propositions to clinicians. To be concrete, the team members, with the liaison clerk playing a central role, met with physicians in charge or with other staff members of the hospital, studied the infection cases in question, and presented the study findings to the clinicians. Fundamentally, therefore, it is not that the ICT intervenes in the affairs of the clinical department by way of directions but that it presents clinicians with the ideas gained through discussion between ICT members and physicians and other hospital staffers. While cementing a relationship of mutual trust between hospital employees, the ICT is expected to engage in nosocomial infection prevention activities by joining forces transdeoartmentally.
Clinical ; Hospitals ; Infection Control ; seconds ; Prophylactic

Apical ballooning cardiomyopathy (Takotsubo or ampulla cardiomyopathy) is a well-known transient and localized left ventricular (LV) dysfunction characterized by apical severe hypokinesis, typical electrocardiogram (ECG) changes of negative T, and a lack of organic lesions of the coronary arteries which could cause myocardial ischemia leading to segmental asynergy. Here we report on two cases of transient cardiomyopathy showing atypically localized asynergy, which is different from Takotsubo cardiomyopathy. Case 1 was diagnosed as atypical Takotsubo cardiomyopathy, and the current findings suggest case 2 was viral myocarditis. These cases suggest that there exist variant patterns of transient cardiomyopathy, and non-invasive and serial clinical evaluations are important for differential diagnosis in acute and atypical cardiomyopathy.
Cardiomyopathy ; Acute ; Cases ; Localized ; Atypical

We held the 49th meeting of The Japanese Association of Rural Medicine in Mie Prefecture in November, 2000. The main theme of this meeting was “Future Aspect of Health, Medicine and Welfare in the next Century, with special reference to the medical service in local community”.
Firstly, I introduced the history of our hospital, that wasestablished in 1938, named Chusei Hospital with 30 beds. In 1993, our hospital was transferred in present place, and renamed Suzuka General Hospital, with 500 beds. Since, our hospital has been recognized as the Suzuka city hospital.
Secondly, I mentioned my career as a cardiologist. My lifelong teacher, Professor Hideo TAKEZAWA, led me a clinician and researcher by bedside teaching, with intense passion and research mind.
Finally, I described a clinical results in the diagnosis and treatment for coronary artery disease in our cardiology division with my colleagues. Especially, focusing in recent one year, we performed percutaneous coronary intervention (PCI) to both native and in-stent restenosis lesions using cutting balloon ^TM. Initial success rate, rate of restenosis and complication rate were favorable results.

In August 1995, a committee was inaugurated in our hospital to improve hospital-patient relationship. Under the auspices of the committee, a series of lecture meetings were held with professional consultants and teachers invited. From September to December in that year, the on-the-job training was started and all the staff and part-time workers participated. The second training was carried out exclusively for people in managerial positions and the committee members from January to February in 1996. From March to June the third training was done for all the staff. The fourth and final training was given to the committee members from July to August in 1996. These on-the-job training and meetings resulted in marked improvements in communication between patients and hospital members. Moreover, the reform image of our hospital has been known widely. From now, we should continue our efforts to improve the hospital-patient relationship through various projects.