Background: There is an increasing demand for general practitioners capable of examining patients from a broad perspective. Although the training of such doctors is urgently needed, the accreditation system was only recently put into place.

Purpose: Our aim was to identify factors that influence career decision-making among doctors who were interested in general practice but chose to be specialists, in addition to finding methods to improve general practitioner training in the future.

Method: From April 2017 to April 2018, we conducted semi-structured interviews with five subjects to understand the process leading up to the selection of their current careers. The verbatim records were analyzed using the modified grounded theory approach.

Results: The reasons given for choosing specialist careers included "attraction as a field of study", "being relied upon by other doctors", and "the sense of security from having a specialty". Cited barriers to entering general practice included "uncertainty about the future" and "criticism from specialists".

Conclusion: Improving the training curriculum for general practitioners will require improvement of the quality of community-based medical education and the general practice board certification system, in addition to the implementation of general practice retraining for specialists.

Introduction: We started the gender-specific clinic for women to provide sufficient treatment for female patients. The purpose of this study was to clarify the characteristics of patients using the gender-specific clinic for women, and to assess the association among depression, physical and mental subjective symptoms.

Methods: This observational study included female patients aged 16-84 years who visited our clinic between June 2012 and December 2015 (N=97). In addition to general attributes, we collected data on physical and mental symptoms, and depression status using the Cornell Medical Index (CMI) and Self-rating Depression Scale (SDS), respectively, at the first visit. We conducted analyses to assess patient characteristics and the association between subjective symptoms and depression, and between physical and mental symptoms by estimating odds ratios (ORs) and 95% confidence intervals (CIs).

Results: The average age of subjects was 50.4 years. The average CMI score was 42.7 points and 55.9% of the subjects were suggested to be neurotic. The average SDS score was 45.0 points and 64.0% of them were suggested to be depressed. The association with depression by SDS was observed in subjective symptoms of CMI such as fatigue (OR [95%CI]: 7.66 [2.26-25.99], p-value: 0.001) and anxiety (OR [95%CI]: 11.73 [1.80-∞], p-value: 0.006). Physical symptoms in the cardiovascular system were positively association with some mental symptoms such as tension.

Conclusion: As female patients often have mental symptoms, it is essential for doctors engaging in gender-specific medicine for women to approach patients while considering psychological and mental aspects.

Objectives: This study examined whether cancer patients who received home care lived in the places they and their families preferred, and whether their preferences changed while receiving home care.

Methods: We conducted a medical record survey of 111 cancer patients who received home care provided by a clinic in Japan, and examined the patients' and their families' preferred places to live in the case of their condition deteriorate (the patients and their families were asked when they began to receive home care, and whenever their and their families' conditions changed), and the actual places where the patients lived out their lives.

Results: Among those who preferred home at the beginning of receiving home care, 95.6% of patients and 96.8% of families preferred home in the last survey period. Of those who did not prefer home at the beginning, 87.9% of patients and 84.8% of families preferred home by the last survey period. For 97.4% of patients and 97.2% of families, the actual places where the patients lived out their lives were consistent with their preferred places.

Conclusion: We found that cancer patients receiving home care provided by the clinic and their families who preferred home from the beginning often still preferred home until the end of their lives, and that those who did not prefer home at the beginning often preferred home by the last survey period. Thus, most of the patients lived out their lives in the places they and their families preferred.

In general, when topical non-steroidal anti-inflammatory patches (hereinafter NSAIDs patches) are prescribed in clinical practice, adverse events, such as gastroduodenal ulcers, are not considered. However, patients often increase the number of NSAIDs patches they use in a single day even though they should only use 1 or 2 for local administration. Daily use of many NSAIDs patches (more than 4 large patches) may maintain the blood concentration of NSAIDs at a significantly level and cause adverse events similar to those by oral administration of standard-dose NSAIDs.

We present a case of prolonged gastric ulcer caused by the daily use of many NSAIDs patches. In this case, Helicobacter pylori infection was negative and no oral NSAIDs were administered, and the discontinuation of NSAIDs patches resulted in the rapid healing of a gastric ulcer that was present for 2 years.

A 68-year-old man underwent surgery for renal cell carcinoma half a year ago, and developed low back and hip pain. The pain did not respond to antibiotics. Collagen disease, in particular ankylosing spondylitis, was suspected and steroids were administered, resulting in the improvement of the symptoms. polymyalgia rheumatica (PMR) was diagnosed.

As all symptoms improved following resection of the metastatic lymph nodes, he was diagnosed with paraneoplastic syndrome. A biological preparation (pazopanib) was administered for renal cell carcinoma, but colon cancer was diagnosed, followed by extirpation of the colon tumor. Although the patient had recurrent thigh pain, he was able to leave the hospital temporarily with walking aids.

This is the first report of PMR as paraneoplastic syndrome after surgery for renal cell carcinoma in a patient with colon cancer.

The realist approach aims to evaluate the process of complex interventions and educational programs that are required in primary care. This is one research method focusing on the clarification of "how and why it works", which has been unclear thus far, and to make it possible to reflect on interventions and processes based on reality. In the realist approach, with realism as a paradigm, researchers collect quantitative and qualitative data, and create an integrated series of context, mechanism and outcome based on the concept of constructive alignment. In this report, the authors introduce an outline of the realist approach using an inter-professional shadowing program evaluation conducted for medical students at a community hospital as an example. It is the authors' goal that scientific evaluation applying realist principles be employed in the field of primary care.

The prevention of dementia is an important issue that should be addressed in Japan. To prevent dementia, it is important to implement interventions (e.g., exercise or cognitive training) for the healthy community-dwelling elderly. However, such interventions are not always evidence-based. In this review, we evaluated exercise and cognitive training intervention protocols for the prevention of dementia based on recent findings. In addition, we proposed specific methods for implementing such interventions in the community.