Association between Undergraduate Education for Community-Based Medicine and General Practice Majors: A Longitudinal Study in Japan / 가정의학회지

Background@#There is a shortage of general practitioners in Japan. With the revision of educational guidelines, general practice (GP) education has improved. However, the amount of education on GP in medical schools remains inconsistent. This study examined the relationship between medical students’ amount of GP-related education and their subsequent choice of GP majors. @*Methods@#A retrospective cohort study was conducted in a teaching hospital in Japan. Participants were residents in the hospital. The exposure comprised compulsory lectures and training time for community-based medicine in medical schools. The outcome included participants choosing GP majors after their initial 2-year junior residency. @*Results@#Fifty-one participants were included in the final analysis. Of these, 14 majored in GP and 37 in non-GP after their initial 2-year junior residency. Of the participants who took GP lectures for 18 hours or more, 11 chose GP majors, and 18 chose non-GP majors (risk ratio, 2.78; 95% confidence interval [CI], 0.88–8.79). Of the participants who underwent training for 12 days or more, 10 chose GP majors, and 16 chose non-GP majors (risk ratio, 2.40; 95% CI, 0.87–6.68). @*Conclusion@#The results do not support the association between the amount of compulsory undergraduate education for community-based medicine and the subsequent increase in the number of residents choosing GP majors in Japan. Educators would do well to explore different approaches, such as improving the quality of education to increase the number of GP residents. Further research is needed to reach more definitive conclusions.

Literature Review of the Establishment of Medical Social Workers' Community Practice / 日本農村医学会雑誌

Some patients requiring medical care wish to continue living at home, so the establishment of a collaborative healthcare system reflecting each community’s characteristics is urgently needed. Medical social workers (MSWs) are one of the professions in this collaborative system. Even though practice guidelines for MSWs include community practice, the main duty of MSWs to date is to support patients at hospital discharge. We, therefore, conduct this literature review to identify desirable MSW’s practice in the community. Based on Japanese studies on MSW's community practice we initially searched, MSW-led interventions were extracted from case reports, and inhibitory factors and promoting factors were extracted from research papers and survey reports. The finding indicates that practice MSWs implemented were “establishment of a collaborative system involves multiple institutions and professionals”, “establishment of a community network that supports patients’ life in the community”, “activation of the community through establishment of opportunities (e.g. gathering places) for residents to interact”, and “promotion for activities in the entire community (e.g., organizing educational classes)”. Data searched were summarized in 4 inhibitory factors and 4 promoting factors, respectively. The inhibitory factors were “activity restrictions due to the rules of institutions MSWs belong to”, “predominance of discharge support in the assigned jobs”, “shortage of allocated workers”, and “ambiguity of job responsibilities unique to MSW”. The promoting factors were “recognition within and outside the hospital, regarding the effectiveness of MSW’s practice”, “promotion of collaboration involving multiple institutions, multiple professionals, and non-professionals in the community”, “meeting the needs of MSW-specific roles”, and “establishment of MSWs' position in the community and their duties inside the hospitals”. As a result, the following points were important to address, which helps establish MSW's community practice: practice that utilizes social workers' perspectives and approaches; building better working environment within the hospital; and establishment of MSW's roles in the community collaboration inside and outside the hospital.

Effect of occupational therapy for delirium patient with carcinomatous meningitis of lung cancer

<b>Purpose: </b>A report of effective occupational therapy for delirium patients with cancer is uncommon. We report a patient of carcinomatous meningitis, in whom her daily activity is improved by occupational therapy. <b>Case: </b>Firstly, we supported her meals and then started occupational therapy accepting her interest. Although degree of confusion and her performance status was not varied from beginning to end, she could concentrate our programmed works and change her way of feelings. Also occupational therapy promotes reminiscence about her life review and friendship among other patients even in delirium condition. <b>Conclusion: </b>Occupational therapy can reduce cancer patients' impatience, anxiety and solitary feelings and improve quality of life.

Treatment with midazolam for sleep disturbance of terminally ill patients with cancer in general wards

<b>Background</b>: In terminally ill patients with cancer, sleep disturbance makes worse their quality of life. Midazolam has not ever been used for the treatment of sleep disturbance in general wards of our hospital, used in palliative care unit of other hospital, however. <b>Method</b>: This is a retrospective study based on chart review. Twenty-eight patients who were treated with midazolam for sleep disturbance included in this study. We designed evaluation methods to strictly follow the actual chart descriptions. Efficacy was rated as good, fair, or poor. Safety was defined by the presence or absence of respiratory depression and hypotension. <b>Results</b>: The median administration periods and initial doses were 6 days (range, 1-151) and 5.0 mg/night (1.8-20.0), respectively. Fourteen patients showed good sleep a night after midazolam infusion, four and nine patients showed fair and poor sleep, respectively. No patient demonstrated a respiratory rate of less than 8/min and systolic blood pressure of <60 mmHg at any point during and after midazolam infusion. <b>Conclusion</b>: Intravenous midazolam appeared to be safe for sleep disturbance of terminally ill patients with cancer in general wards. A future improvement administration methods are necessary to treat for sleep disturbance more effectively as well as PCU.

Acute hemorrhagic rectal ulcer in a patient with lung cancer

<b>Purpose</b>: Acute hemorrhagic rectal ulcer (AHRU) commonly occurs in elderly who are bedridden for long time due to severe underlying diseases such as cerebral and myocardial infarction and their complications. However, it is uncommon in end-stage cancer patients receiving palliative care. We report a rare AHRU case in his forties who had lung cancer with paraplegia due to tumor invasion. <b>Case</b>: A male lung cancer patientwas admitted to our hospital for new-onset paraplegia caused by spinal cord invasion. On 25th day after admission, he suffered from a little rectal bleeding. From that day, a painless rectal bleeding becomes gradually increased. On 37th day, a massive bleeding was occurred. Endoscopy showed that there was no active bleeding but an exposed vessel and partial circumferential ulcer in the lower part of rectum, which was compatible with the finding of AHRU. The lesion was successfully treated by clipping and no re-bleeding was observed after clipping. He was discharge on 103rd day. <b>Conclusion</b>: AHRU should be considered in the differential diagnosis of a massive melena in end-stage cancer patients. Prompt diagnosis and therapy is important because this disease is curable even in the terminal stage to improve their quality of life. Palliat Care Res 2011; 6(1): 308-312