Why Japanese frail elderly men refuse social network? : a qualitative study / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : Japanese elderly men tend to refuse social network even if they need to use them. The objective is to explore Japanese elderly men's perceptions of social network including daycare services.<br><b>Methods</b> : Qualitative studies using focused group and semi-structured interviews for elderly men more than seventy-five years old who live in Nagi-cho, Okayama, Japan were conducted.. All interviews were recorded and transcribed. Data analysis was done with modified grounded theory approach.<br><b>Results</b> : Three categories were made as internal factors (role seeking, adapt aging), relationship factor (female attendance, staff communication), and external factor (transportation, economy).<br><b>Conclusion</b> : By conducting intervention focusing on causes of relationships and external factors inclusive of day care services , it may be possible to improve social involvement of elderly men. 10 proposals were made to government.

A web-based cross-sectional survey of selective medical school admissions for medically underserved areas / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : Selective admission for medically underserved areas (Chiiki-Waku) has been increasing, but qualifications vary. We investigated the current state of these selective admissions to gain a better sense of their nature and to elucidate problems.<br><b>Methods</b> : A web-based cross-sectional survey was conducted among 77 medical schools that accepted applications for selective admission for medically underserved areas in 2013.<br><b>Results</b> : There were a total of 1305 applicants for 148 slots at 62 universities. We observed 86 admissions at national universities, and 90 admissions through recommendation/ admissions office-based entrance exams. Thirty programs placed restrictions on employment after graduation, 84 required accepting scholarships, 8 required joining a specific organization as a condition in the pledge and 83 placed limits on place of origin of the applicant. Only 13 programs had special curricula for education in community medicine.<br><b>Conclusion</b> : In some Chiiki-Waku, problems such as restriction on employment, the obligation to accept scholarships, and other inappropriate conditions were noted. Definition of students from rural backgrounds in Japan differs from the WHO guideline definition. Few programs offer special curricula covering community medicine.

A web-based cross-sectional survey of municipal government scholarships associated with selective medical school admissions for medically underserved areas / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : Municipal government scholarships for the purpose of support of rural health & medically underserved areas has increased, but repayment exemption conditions of the scholarships vary. We conducted a survey of scholarships to clarify their impact on physician careers.<br><b>Methods</b> : A web-based cross-sectional survey was conducted from November 2013 to January 2014 among municipal governments administering scholarships associated with selective medical school admissions for medically underserved areas in 2013.<br><b>Results</b> : There were 59 scholarships administered by 42 municipal governments connected with 53 universities. The mode of the total loan amount was 14.4 million yen. Features of the loan agreements were a high repayment interest rate (over 10%) in 70% of the scholarships and a requirement for lump-sum repayment in 41 scholarships. Three programs allowed free choice of residency training for 3 years or more during the obligatory term, while 48 programs did not allow such choice during the entire obligatory term.<br><b>Conclusion</b> : Eighty-percent of the scholarship programs do not allow for the minimum 3 years of basic post-graduate training required by specialty training program guidelines. In order to prevent the anticipated reduction in future applicants to these scholarship programs, appropriate interest rates, repayment rules, and allowance for specialty training are required.

Introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : As one of the strategies for the introduction of collaborative drug therapy management (CDTM) into a community healthcare system in Japan, we constructed a ‘positive list’ which was agreed by a family physician in advance, and subsequently validated the effects on healthcare insurance fees, the number of prescription question and the changes of utilization rate for generic drugs.<br><b>Methods</b> : The items that replaced prescription questions with regard to ex post facto approval were defined as ‘Resolved Questions’ in our constructed positive list. By adopting the ‘Resolved Questions’, we then examined the effect on healthcare insurance fees, prescription questions and the changes of utilization rates for generic drugs.<br><b>Results</b> : Among all prescription questions accepted from January through May 2012 inclusive, 178 (22.7%) were ‘Resolved Questions’, without there being change in the therapeutic strategies by the prescribing physicians. During this period, 17,455 healthcare insurance fees were reduced. In addition, the utilization rate for generic drugs were increased up to 46.6%.<br><b>Conclusion</b> : The reduction of healthcare insurance fees, prescription questions and the increased utilization rates of generic drugs were facilitated by prudent pharmacist judgements based on ‘Resolved Questions’.

Evaluation of the Interview Skills at the Opening of the Medical Interviewing / 医学教育

We evaluated the interview skills of 46 sixth year medical students (32 men, 14 women) in our outpatient clinic. Six items were evaluated, including the manner in which students responded to patients, the number of times students interrupted patients' statements with closed-ended questions, and the extent to which students maintained eye contact with patients. We found that students interrupted patients every 46.2 seconds on average, and often did not make eye contact with tha patients. It became clear that, although we teach medical interview skills to students, students do not learn these skills very well. We suggest that in order to properly educate medical students, close cooperation between departments is needed.

Evaluation of Student Skills in Basic Minor Surgery Using the Object Structured Clinical Examination / 医学教育

We evaluated basic surgical skills in students using the Objective Structured Clinical Examination (OSCE). The study was conducted on 101 sixth-grade medical students (67 males, 34 females) at Kawasaki Medical School in 1993. Theme A (tying of a silk suture) was given to 44 students, and theme B (tying of nylon suture using surgical instruments) was given to 57 students. The following items were evaluated (1) handling of surgical instruments, (2) suturing, (3) knot tying, and (4) suture removal. The average score for theme B was slightly lower than that for theme A. The average score for knot tying was lower than scores for the other items. Thus, it was revealed that all students were not good at tying knots. These scores for minor surgery correlated with the scores for other skills as evaluated by the OSCE. In conclusion, the OSCE appears to be an appropriate method for evaluating basic surgical skills.