Recently in Japan, "transition of care" cases, in which patients are transferred from a medical institution that had once provided medical care to a new one and the medical care provider is therefore changed, are increasing. However, the concept of "transition of care" and "undesirable outcomes in patients accompanied by care transition" have been studied very little in Japan. The concept of "transition of care" consists of factors such as patient background (age, underlying disease, and family's caregiving ability), transfer of clinical information, and tools to transfer clinical information. In Europe and the USA, undesirable outcomes accompanied by care transition, such as "medicamentous adverse events", "clinical examination data taken during hospitalization are not confirmed", and "medical care planned for a patient is not implemented", are reported to have occurred for 19% to 50% of patients who had been discharged from hospitals and transferred to clinics. It is also necessary to understand the state of care transition in Japan and investigate countermeasures compatible with the Japanese medical care system.

We report a rare case of primary cardiac angiosarcoma in the right atrium. A 47-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography revealed a tumor in the right atrial cavity. We performed tumor resection to confirm the histological diagnosis, to prevent tumor embolism, and to increase the possibility of improving the prognosis. The tumor was resected with the right atrial wall and right pericardium. The right atrium was then reconstructed with a bovine pericardial patch. The pathological diagnosis was angiosarcoma. The patient survived only about 6 months after surgical resection, but there was no local recurrence. This report presents a very rare case of cardiac angiosarcoma associated with cardiac tamponade.

In a 63-year-old male patient Jehovah's witness, IABP was introduced due to acute myocardial infarction and cardiogenic shock, and PCI (BMS) was carried out to CAG #7 100%. Stent placement was carried out and his hemodynamics stabilized. A left-to-right shunt was observed upon carrying out LVG, so the patient was referred to our hospital for surgery purposes due to a diagnosis of ventricular septal perforation (VSP). Upon transferring the patient to hospital, his PA pressure elevated to 53 mmHg although the blood pressure was maintained, and no findings of right heart failure were observed. His respiratory condition was stable. Emergency surgery was considered, but the patient was taking Clopidogrel following PCI, and so VSP repair (extended endocardial repair) was carried out following 4 days discontinuation of Clopidogrel. Preoperative anemia was not observed ; however, postoperative hemorrhagic anemia improved due to iron preparation administration, and the patient was discharged from hospital 22 days following surgery without blood transfusion.

Background: A depressive state for residents during residency training is a serious problem. Enhancement of senior doctor's support is considered to be one preventive measure, but it is uncertain whether onset of a new depressive state during training is related to senior doctors' support.
Methods: A dual questionnaire survey was conducted in 2003 on 608 first-year residents at 40 teaching hospitals in Japan. Residents who had not been in a depressive state at the time of the first survey-using the Center for Epidemiologic Studies-Depression (CES-D) Scale, but were in a depressive state at the time of the second survey were defined as “residents in a new-onset depressive state.” The degree of senior doctors' support was assessed with Senior Doctor's Support Scale (SDSS), then adjusted OR and 95% CI of the residents in a new-onset depressive state were computed with a multivariate logistic regression model.
Results: 82 residents (24.4%) were determined to be “residents in the new-onset depressive state.” The mean CES-D Score of Low SDSS Score Group (n=24), Middle SDSS Score Group (n=100), and High SDSS Score Group (n=152) were 20.0 (SD=9.9), 13.8 (SD=8.7), and 11.0 (SD=8.0), respectively (p<0.001). With logistic regression, residents who could fall into a depressive state during residency training were considered to be those who achieve middle SDSS Score (OR: 3.04, 95% CI: 1.45-4.80) and low SDSS score (OR: 17.89, 95% CI: 4.83-66.30).
Conclusion: Because onset of residents' depressive state is related to senior doctors' support, we should enhance support during residency training.

1)Continuing medical education (CME) systems were researched in 10 countries. In all countries but one CME is mandatory. Only Spain has voluntary CME, as does Japan.
2)The traditional CME systems in many countries were changed after 2000. We believe this change reflects a global revolution associated with a new wave of medical risk management.
3)To provide better medical services, we must keep improving Japan's CME system. Such improvement is an important responsibility to society.

Objective: The present study examined the status of the provision of drug information to hypertensive patients at community-based pharmacies by evaluating patients' satisfaction, understanding, and wishes.
Design: A cross-sectional study was conducted by surveying patients using a self-administered questionnaire.
Methods: Three items were evaluated: 1) the level of patient satisfaction with provision of drug information; 2) the level of patient understanding of information provided on antihypertensive drugs; and, 3) patient wishes regarding provision of drug information.
Results: The level of satisfaction with provision of drug information was high (86.6%). Although patients were found to understand the precautions for use of antihypertensive drugs, their understanding of drug efficacy was insufficient. Also, patients wished to receive more explanation from pharmacists regarding the efficacy of drugs in addition to explanations of associated adverse reactions or precautions for use of the drugs.
Conclusions: Hypertensive patients were highly satisfied with the provision of drug information at community-based pharmacies, but did not show sufficient understanding of the efficacy of antihypertensive drugs, an issue to be addressed in the future by pharmacists in their instructions to patients on the use of drugs.

In Europe and America, it is reported that residents develops burnout syndrome or depression by their stress, and these are connected with dropouts from their training program and undesirable outcomes of the patients such as unethical practice. Recently, though resident's poor working conditions and death from overwork, etc. become problems also in Japan.But, Japanese resident's stressor is uncertain.
1) Focus group interview was executed for 25 junior residents in 10 facilities, and their stressor were explored.
2) As a result, three cateogories ; physiological stressor as one human being, stressor as a new member of society, and stressor as a trainee doctor and beginner novice doctor was extracted.
3) Three stressors were named the life gap, the society gap, and the profession gap respectively. The stressor of junior resident was described as the product what was born by the gap of medical student and becoming a doctor.
4) Japanese residents have various stressors. Stressor as a trainee doctor was a stressor peculiar to Japanese junior residents.
5) Stress management should be done considering such a stressor in the light of safety and effective clinical training.

This study explored the general public's perception of the clinical competence of residents. Methods: Individual interviews of laypersons, medical students, and residents and focus-group interviews of residents were conducted. Results: Individual interviews revealed the belief that residents acquired various clinical skills immediately after passing the national examination for medical practitioners. These skills included: assessment of the need for referrals, on-call jobs for after-hours and emergency services, interpreting X-ray films, performing cardiopulmonary resuscitation, performing surgery for appendicitis, and treating bone fractures and joint dislocations. Focus-group interviews revealed differences between residents and laypersons in the perception of residents' clinical skills. These skills included: general knowledge of diseases and medications, guidance about lifestyle after discharge, physical examinations, explanation of treatment, diagnostic imaging, and knowledge of or expertise in other medical professions. Conclusion: Laypersons and medical personnel have different perceptions about the clinical competence of residents.

Increased emphasis on community-based education in medicine requires close collaboration with and cooperation from general practitioners. This study examined what motivates community physicians to participate in office-based education, to explore the most appropriate method for recognizing physicians' efforts and keeping them motivated with their precepting role. A large majority of respondents to a questionnaire survey thought that the opportunity to learn from their own teaching was an important reward. When the preceptors were asked what support would be most appropriate, a teaching certification plaque, continuing medical education courses, and a title were ranked highest, while financial reward was listed as the least important. Considered most essential by community preceptors were constructive feedback from students, medical-school instructors' understanding of the importance of community-based medicine, and the instructors' enthusiastic promotion of primary-care education.