“Standardization of Pre-Graduate Curriculum” in Kampo Medical Education”: Purpose and Background of the Establishment of the Japan Council for Kampo Medical Education / 日本東洋医学雑誌

In 2015, the Japan Council for Kampo Medical Education was established to create a basic curriculum for Kampo medical education that could be implemented in medical schools nationwide. After conducting a needs assessment, we decided on a lecture time of 240 minutes. To set learning objectives, we formed groups for “history,” “examination methods and patterns,” “effects of Kampo medicine,” “clinical cases,” “acupuncture and moxibustion,” and “evaluation.” The teaching contents were incorporated. Then, model slides and lecture guides containing these teaching contents were created, and textbooks based on these contents were published in 2020. In 2021, these overall efforts and contents were made public nationwide, providing an opportunity for the introduction of this curriculum at each university.

Report of the 71st Annual Meeting of the Japan Society for Oriental Medicine Special Program 1-“Pre-and Post-Graduation Education of Kampo Medicine for the Next Generation”: Standard Lecture on Kampo Medicine / 日本東洋医学雑誌

At the 71st Annual Meeting of the Japan Society for Oriental Medicine held in August 2021, we conducted a special program, “Pre-graduation and post-graduation Kampo medical education for the next generation,” focusing on Kampo medical education. We summarize and report a mock lecture on standard Kampo medicine conducted jointly with the Japan Council for Kampo Medical Education (JCKME) for the purpose of faculty development. The lecture contents were based on the “Basic Curriculum for Pre-Graduate Education in Kampo Medicine 2016” established by the JCKME, and the common model slides prepared by the JCKME were used. The lectures were pre-recorded for 240 minutes on the “History of Kampo medicine,” “basic theory of Kampo medicine,” “physical examination of Kampo medicine,” “composition and effects of typical Kampo medicines, effects and side effects of typical herbal medicines,” “usefulness of Kampo and clinical cases that were effective,” and “overview of acupuncture and moxibustion treatment,” and were delivered from seven days before to seven days after the annual meeting. This was the first nationwide educational activity for the general meeting of the society. These lectures were viewed 1,017 times nationwide, by medical students, educators, and members of the society.

Family Involvement by Japanese Family Physicians in Their Clinics: The Second Report of a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify the involvement of Japanese family physicians with patients and their families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checks. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checks and external checks.Results: Eight physicians participated at first, but five of them dropped out because of job commitments or death. The involvement by Japanese family physicians consisted of three stages. The first stage was "the approach of repeated hypothesis testing and normalizing" as safety interventions. The second stage was "reevaluation of the family" utilizing family genograms, family conferences, and others. After exhausting all other efforts, they engaged in "accepting the one who comes to them" in collaboration with the patient and families. The outcomes included awareness of patients, their smiles due to feeling accepted, and their expressed emotions. They did not explicitly boast that they were able to engage with family members. In addition, they also needed case studies of instances of "failure." Conclusion: Japanese family physicians engaged in three-stage involvement with families.

How and When Do Japanese Family Physicians Assess Family in Their Clinics?: A Preliminary Initial Report from a Focus Group Discussion / 日本プライマリ・ケア連合学会誌

Objective: To clarify how and when Japanese family physicians assess families in their daily practice.Methods: Participants were Japanese family physicians with over one year of experience of full-time work in their clinics, and who were able to join the focus group discussions (FGD) and member checking. The study employed a qualitative research design with semi-structured FGD. Two analysts examined video recordings of the FGD, and the results were verified through member checking and the checking by external members.Results: Physicians assessed families naturally while examining patients for common cold, during vaccination, and during registration in the Japanese care insurance system.Additionally, the physicians assessed the families when they observed or suspected something strange regarding the patient and/or the family.Families were assessed based on how they spent their time during special Japanese events that the family members attended together (e.g., Bon festival or Japanese style New Year holidays), the patient's illness behavior in non-reserved outpatient clinics, and their communication patterns. Furthermore, the family photograph technique for family therapy was also used for assessment.Conclusion: Participants utilized skills of family therapy such as communication patterns and family photographs. They also employed unique skills such as assessment of the families' sharing time during traditional events, assessment of the patient's illness behavior, and general assessments regarding the Japanese care insurance system.

<b>Endolymphatic Hydrops as a Clinical Condition in Traditional Oriental Medicine —Is an Endolymphatic Hydrops Condition the Same as </b><i><b>Suidoku</b></i><b>? Analysis of Endolymphatic Hydrops by Traditional C / 日本東洋医学雑誌

<p>Endolymphatic hydrops, regarded as a marker of Ménière's disease, can now be diagnosed using MRI. Since endolymphatic hydrops is considered a condition of fluid disturbance known as <i>suidoku </i>in Kampo medicine, Kampo preparations with a water flow smoothing ability are often used to treat endolymphatic hydrops. However, the hypothesis that endolymphatic hydrops is <i>suidoku </i>indication has not been fully tested. We used traditional Chinese medicine to diagnose patterns in 11 patients who had been diagnosed with endolymphatic hydrops using MRI. Additionally, we researched the literature regarding the condition of fluid disturbance and resulting vertigo. Of the 11 patients, seven showed disorder of fluid, eight showed kidney (traditional medicine, TM) disorder, and five showed liver (TM) disorder. According to the literature, the vertigo condition caused by fluid disturbance was described in the chapters “tanyinkesoubing and shuiqibing” in the “Jinguiyaolue”. Since no auditory symptom is mentioned in these chapters on vertigo, vertigo caused by fluid disturbance might differ from typical Ménière's disease with auditory symptoms. It is suggested that the patients with endolymphatic hydrops do not necessarily indicate <i>suidoku </i>and we should consider the states of kidney (TM) and liver (TM) disorders.</p>

Knowing the Patient Better : How Facilitated Sharing of Diabetes Patients' Life Stories Enhances Patient-Physician Relationships but not Metabolic Control / General Medicine

<b>BACKGROUND</b>: The patient-physician relationship and patient self-management are important in controlling diabetes mellitus. This pilot study assessed the value of patients sharing their stories with physicians.<br><b>METHOD</b>: Twelve patients and two physicians participated. Patients told their life stories to a co-medical interviewer, and these were transcribed and summarized in their medical charts. The physicians read the transcripts. The intervention was evaluated by questionnaire and interviews with the patients and physicians. Two coders qualitatively analyzed the interviews. Glycated haemoglobin (HbA1c) and body weight were examined before and six months after the intervention.<br><b>RESULTS</b>: 75% of patients felt an improvement in the physician's empathy, advice and ability to share the patient's problems. Physicians reported an improved relationship with 40% of the patients. The patient interview identified: 1) facilitated self-reflection; 2) encouraged self-efficacy; 3) changed perceptions about health-care related behavior; and, 4) difficulties in changing behavior. However, improvement in HbA1c levels and body weight was not significant.<br><b>CONCLUSIONS</b>: The patients were satisfied that sharing their stories improved self-reflection and self-efficacy, but found it difficult to adopt healthier options for managing their diabetes. Long-term study of whether improved physician communication skills will enhance outcomes is needed.

Knowing the Patient Better: How Facilitated Sharing of Diabetes Patients' Life Stories Enhances Patient-Physician Relationships but not Metabolic Control / General Medicine

<b>BACKGROUND</b>: The patient-physician relationship and patient self-management are important in controlling diabetes mellitus. This pilot study assessed the value of patients sharing their stories with physicians.<br><b>METHOD</b>: Twelve patients and two physicians participated. Patients told their life stories to a co-medical interviewer, and these were transcribed and summarized in their medical charts. The physicians read the transcripts. The intervention was evaluated by questionnaire and interviews with the patients and physicians. Two coders qualitatively analyzed the interviews. Glycated haemoglobin (HbA1c) and body weight were examined before and six months after the intervention.<br><b>RESULTS</b>: 75% of patients felt an improvement in the physician's empathy, advice and ability to share the patient's problems. Physicians reported an improved relationship with 40% of the patients. The patient interview identified: 1) facilitated self-reflection; 2) encouraged self-efficacy; 3) changed perceptions about health-care related behavior; and, 4) difficulties in changing behavior. However, improvement in HbA1c levels and body weight was not significant.<br><b>CONCLUSIONS</b>: The patients were satisfied that sharing their stories improved self-reflection and self-efficacy, but found it difficult to adopt healthier options for managing their diabetes. Long-term study of whether improved physician communication skills will enhance outcomes is needed.

Associations between physical strength, cerebral function and mental health in independent-living elderly Japanese women

<p><b>OBJECTIVES</b>To evaluate the physical strength, cerebral function, and mental health conditions in elderly persons, and to examine the correlation between these functions.</p><p><b>METHODS</b>The subjects were 151 independent-living elderly Japanese women, mean age 70 +/-5 years (+/-SD; range, 60 to 80 years), with normal abilities in daily life. The health check-up was conducted from April to May 1997. Physical strength was estimated by measuring seven activities. Cerebral functions were assessed by six sub-tests of the General Aptitude Test Battery (GATB). Their mental health status was measured by four sub-scales of the General Health Questionnaire (GHQ)-28.</p><p><b>RESULTS</b>The physical strenght and almost all of the cerebral functions decreased with age. Social dysfunction and severe depression on the GHQ sub-scales also worsened with age. Physical strength was strongly correlated with cerebral functions after adjusting for the confounding effect of aging. There were also interrelations between physical strength and mental health.</p><p><b>CONCLUSIONS</b>This study provided important information on the correlation between physical and mental status in elderly women. Future longitudinal studies with the intervention of physical training are required to determine whether a causal relationship exists between these factors.</p>

Associations between Physical Strength, Cerebral Function and Mental Health in Independent-Living Elderly Japanese Women

Objectives: To evaluate the physical strength, cerebral function, and mental health conditions in elderly persons, and to examine the correlation between these functions. Methods: The subjects were 151 independent-living elderly Japanese women, mean age 70 +/− 5 years (+/− SD; range, 60 to 80 years), with normal abilities in daily life. The health check-up was conducted from April to May 1997. Physical strength was estimated by measuring seven activities. Cerebral functions were assessed by six sub-tests of the General Aptitude Test Battery (GATB). Their mental health status was measured by four sub-scales of the General Health Questionnaire (GHQ)-28. Results: The physical strength and almost all of the cerebral functions decreased with age. Social dysfunction and severe depression on the GHQ sub-scales also worsened with age. Physical strength was strongly correlated with cerebral functions after adjusting for the confounding effect of aging. There were also interrelations between physical strength and mental health. Conclusions: This study provided important information on the correlation between physical and mental status in elderly women. Future longitudinal studies with the intervention of physical training are required to determine whether a causal relationship exists between these factors.

Effects of different types of physical training on insulin action in human peripheral tissues. Use of the euglycemic clamp technique / 体力科学

Physical training has been shown to improve glucose tolerance and insulin action in peripheral tissues. In the present study, regular (R) and high (H) -dose euglycemic clamp procedures were performed to determine the effects of different types of physical training on insulin action (sensitivity/responsiveness) in 10 long-distance runners (LR), 10 weight-lifters (WL) and 12 healthy controls (HC), The amount of infused glucose (glucose metabolism, GM) during euglycemic clamping is a measure of the peripheral tissue sensitivity and/or responsiveness to insulin. For R clamping, when GM was calculated per unit body weight (BW), GM in LR (11.92±1.22 mg/kg BW·min) and WL (9.28±0.63 mg/kg BW·min) was significantly (P<0.05) higher than that in HC (7.44±0.39 mg/kg BW·min) . When calculated per unit lean body mass (LBM), LR (15.07±1.56 mg/kg LBM·min) differed from HC (9, 15±0.59 mg/kg LBM·min, P<0.05), whereas the value in WL (11.50±0.93mg/kg LBM·min) was identical to that in HC. For H clamping, there was no significant change in these three groups when GM was calculated per unit BW or LBM. These results suggest that enhancement of insulin action by physical training is due to an increase in insulin sensitivity, rather than to an increase in insulin responsiveness, and that aerobic exercise, for example long-distance running, is more effective for the improvement of decreased sensitivity to insulin, which is observed in patients with simple obesity and diabetes, than anaerobic exercise such as weight-lifting.