Mental Health Competencies in Family Medicine Residency Training / 日本プライマリ・ケア連合学会誌

In recent years, the integration of mental health into primary care has become a global trend, as it is recognized to be effective for providing appropriate treatment, improving outcomes, and using resources appropriately. Therefore, in many countries, mental health education in primary care has been developed and delivered. However, systematic training on mental health for family physicians has not been sufficiently provided in Japan. We performed a scoping review in order to clarify the mental health competencies of primary care physicians by analyzing the educational curricula in other countries using thematic analysis. The competencies extracted were comprehensive and classified into three domains: "general competencies in primary care," "general competencies in mental health in primary care," and "specific competencies in mental health in primary care". In the future, it will be necessary to create a competency list based on the reported data and formulate a model curriculum based on the current situation in Japan.

Multimorbidity in Primary Care: Current Situation and Research Gap / 日本プライマリ・ケア連合学会誌

In the 1980s, some researchers started using the word "multimorbidity", which is defined as "the co-existence of two or more long-term conditions in an individual". Multimorbidity has become one of the most important topics in recent primary care because of its clinical significance. Multimorbidity is more common among the elderly, and was suggested to be associated with female sex, lower socio-economic status and mental disease. Multimorbidity is associated with a higher mortality, lower quality of life and reduced functional status. It is also associated with the treatment burden such as consultation frequency, fragmented healthcare provision and inadequate polypharmacy. Multimorbidity has negative impact on health care resource use such as hospital visits, unexpected admission and total health care costs. However, the total picture and health care effects of multimorbidity have only been reported in observational studies, and there is little evidence of which interventions are effective for multimorbidity patients. In this review paper, we carried out a literature review of high-quality reports from Japan and overseas. We provide an overview of the current situation of multimorbidity research and highlight the research gaps. Based on these results, we would like to propose approaches for multimorbidity patients in clinical settings.

Successful elimination of intractable anal pain associated with rectal cancer by combination of subarachnoid phenol block with sacral nerve root thermocoagulation

<b>Purpose</b>: We report a case whose anal pain accompanied by rectal cancer was remarkably eliminated by subarachnoid phenol block and sacral nerve root thermocoagulation. <b>Case Report</b>: The subject was a sixty-one-year old male. His anal pain failed to respond to opioid whereas his pain was alleviated by subarachnoid phenol block, but was exacerbated a few weeks later. This relapsing pain was completely eradicated by sacral nerve root thermocoagulation. <b>Conclusion</b>: Anal pain associated with rectal cancer recurrence of pelvic space is sometimes hard to be controlled only by subarachnoid phenol block, but there is a possibility of pain control by combination use with sacral nerve root thermocoagulation. Palliat Care Res 2010; 5(2): 314-316