Yukihiro Ikeda

Professionalism is widely known as extremely important to the practice of medicine. However, a methodology has not been established in Japan, such that teachers-in-charge at medical schools are using personal strategies in conducting classes. Evidently, research on professionalism education in Japan is lacking. Therefore, the study aims to report an improvement plan for professionalism education in a certain medical school in Japan with emphasis on practice. Specifically, the study focuses on problem extraction and targets medical students in the first year. The problems of the program were extracted for learner, grouping, facilitator, and presentation. Program improvements were implemented for each of these parts to overcome the problems. The result shows that students gained a better understanding of their roles until graduation. In addition, the number of students who answered that this program was the most memorable in 2019 has tripled compared with that in 2018. Regarding the program improvement, the effect of the program cannot be concluded based on this result alone. In the future, these students should be followed up to investigate any changes. In addition, feedback from each facilitator should be investigated as a future endeavor. Keywords: Professionalism; first-year student; program improvement Keywords: Professionalism; first-year student; program improvement

This article was migrated. The article was marked as recommended. The results from a comprehensive survey of students' perceptions of their educational environment using the Dundee Ready Educational Environment Measure (DREEM) in our Medical School were compared with students' school learning scores. The subjects (n=495) were medical students beyond their first year of medical school. The students were asked to read each DREEM statement carefully and respond using a 5-point Likert-type scale, with responses ranging from strongly agree to strongly disagree. The mean total DREEM score was 113.4, and there was no significant difference among total DREEM scores for students in different school years. Sixth-year students scored significantly higher than those in the second year for the Academic Self-Perception and Social Self-Perception domains. Females had higher school learning scores and also had better total and Perception of Course Organizers DREEM scores. The DREEM score tended to be lower for those with lower school learning scores, with significant differences found for total, Academic Self-Perception and Social Self-Perception scores. This is the first study to use the DREEM score for Japanese medical students, and further prospective research is required to obtain a complete understanding of the results.

Background: Domestic medical waste from Home Medical Care (HMC) is a concern in Japan. In 2005, the Japanese government provided that HMC waste is collected by municipalities. HMC waste includes infectious or sharps, thus such waste should be collected by doctor or nurse. Nevertheless, no studies have examined the collection of separate HMC waste items, such as needles and infectious agents. Objective: To demonstrate the current HMC waste collection status for individual items and to assess whether HMC waste collection rate by nurses has been changed since the initial study. Methods: A questionnaire was mailed and delivered 1,022 offices, from which 677 office nurses replied for the follow-up study, 27 had closed down, and five had integrated with other offices. Thus, the final analysis was conducted in 645 offices. Offices were classified into three groups according to the size of the local population. Results: Most of the used syringes and needles, were collected by a nurse or doctor. More nurses in small-sized cities collected used syringes and needles from patients’ homes than nurses in medium- or large-sized cities. In contrast, more doctors in large-sized cities collected used syringes and needles from patients’ homes than doctors in small- or medium-sized cities. HMC waste collection rates by nurses for all city sizes had decreased since the baseline study. Both 2009 and 2015 study, the collection rate of HMC waste by nurse was as high as small-sized city and lower as large-sized city. The trend of this did not change over six years. Conclusion: The collection rate of HMC waste by nurses has declined in the last six years. This indirectly indicated that the HMC waste collection rate of municipalities improved in six years. Safe HMC waste collection program awareness should be promoted among nurses, doctors and patients. It is necessary for healthcare workers to work in cooperation with municipalities. The development of standardized guidelines for HMC waste handling protocols should be a priority for all municipalities.

A questionnaire survey was conducted to determine the current status of home medical care (HMC) waste collection by nurses for individual items and whether the collection rate differs with city size. The questionnaire was mailed to 1,022 nursing offices, of which 645 offices provided valid responses. Offices were classified into three groups according to the local population size. Responses indicated that used syringes and needles, except for pen-type self-injection needles, were collected by >50% of HMC nurses. On the other hand, enteral nutrients, nutritional adjustment diet vessels, feeding tubes, portable injectors, ventilator masks, endotracheal suction catheters, tracheal cannulas, continuous ambulatory peritoneal dialysis (CAPD) bags, and urinary catheters and bags had a low collection rate in comparison with syringes or needles. The collection percentage of used syringes, needles, and infusion needles (p < 0.05) and that for infusion bags, tubes, and catheters (p < 0.001) differed among the three population groups. Although municipalities are responsible for collect all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses. On the contrary, nonhazardous HMC waste should be collected by municipalities. Implications: This paper illustrates the status of waste collection of individual home medical care (HMC) items by HMC nurses. Infectious waste, such as needles and syringes, is collected by nurses. The collection rate of infectious waste by nurses in large cities was low compared with that in small cities. Although municipalities are responsible for collecting all HMC waste, sharp or infectious items should be collected by HMC doctors or nurses, whereas nonhazardous HMC waste should be collected by the municipalities.

Metastin/kisspeptin is an endogenous ligand of KISS1 Receptor (KISS1R). Metastin and KISS1R are suggested to play crucial roles in regulating the secretion of gonadotropin-releasing hormone (GnRH), and continuous administration of metastin derivatives attenuated the plasma testosterone levels in male rats. Our optimization studies of metastin derivatives led to the discovery of 1 (Ac-d-Tyr-d-Trp-Asn-Thr-Phe-azaGly-Leu-Arg(Me)-Trp-NH₂, TAK-683), which suppressed plasma testosterone in rats at lower doses than those of leuprolide. Although 1 possessed extremely potent pharmacological activity, 20 mg/mL aqueous solution of 1 has a gel formation property. In order to improve this physicochemical property, we substituted d-Trp at position 47 with a variety of amino acids; we identified that substitution with cyclic amino acids, which could change peptide conformation, retained its potency. Especially, analogue 24 (TAK-448) with trans-4-hydroxyproline (Hyp) at position 47 showed not only superior pharmacological activity to 1 but also excellent water solubility. Furthermore, 20 mg/mL aqueous solution of 24 did not show gel formation up to 5 days.

The Japanese Population-based Osteoporosis (JPOS) Cohort Study was launched in 1996 to produce a reference database of areal bone mineral density (aBMD) by dual energy X-ray absorptiometry (DXA) and bone turnover markers in the Japanese female population and to determine risk factors for osteoporotic fractures. At baseline, 3984 women aged 15 to 79 years were randomly selected to provide representative bone status data and aBMD values for the diagnosis of osteoporosis. Follow-up surveys were conducted in 1999, 2002, 2006 and 2011/12 to determine changes in aBMD and identify incident morphometry-confirmed vertebral fractures and clinical fractures. These outcomes were obtained from 2174 women who participated in at least one follow-up survey. JPOS is a unique resource of individual-level bone health information with radiological and biological archives that include DXA images, and serum, plasma and DNA for future analyses with emerging radiological and biological techniques. The JPOS dataset is not freely available, but new collaborations are encouraged. Potential collaborators are invited to contact the Secretary General (M.I.) at the administrative office of the JPOS Study Group.