Introduction: The learning and practice of bereavement care by Japanese family practitioners has largely been unexplored. The purpose of this study was to clarify what family doctors thought they learned by providing care for bereaved families and how they changed because of it.

Methods: Semi-structured interviews were conducted with seven family practitioners working in bereaved family outpatient care at the researcher's hospital. A modified grounded theory approach was used for the analysis.

Results: The analysis identified five thematic categories: 1) the doctor's feelings and thoughts before learning about bereavement care, 2) things they learned from providing bereavement care, 3) things they learned by interacting with the families and things they learned upon reflections afterward, 4) changes in themselves, and 5) changes in their feelings after learning about bereavement care.

Conclusion: The doctors learned to provide bereavement care by directly interacting with families and by reflecting on those experiences; for example, they learned to listen and be empathetic, and to understand individuals' personal responses to grief. As a result, they may have gained the ability to have a more rounded view of life and death and of their role in helping families adjust to the death of a family member.

Introduction: There is an increasing number of reports demonstrating that dietary small bowel obstruction caused by rice cake consumption can be treated conservatively. However, the course of conservative treatment and the characteristics of the cases that require surgery remain unclear. The purpose of this study was to clarify the clinical features of small bowel obstruction caused by rice cake consumption and the characteristics of cases that require surgery.

Methods: We retrospectively assessed all cases of intestinal obstruction caused by rice cake consumption treated at a single institution over a period of 7 years. We also assessed similar previously reported cases.

Results: We assessed nine cases in our study and reviewed 67 previously reported cases. Conservative treatment was employed in 56 cases (73.7%). Dietary small bowel obstruction caused by rice cake consumption occurred 1.7 ± 0.3 days after intake. The computed tomography (CT) value of rice cake in the intestine was 160.0 ± 8.9 Hounsfield Units. Pieces of rice cake (length ≥ 4 cm) were observed in five of six cases in which rice cake consumption caused intestinal perforation.

Conclusion: In most cases, patients with dietary small bowel obstruction caused by rice cake consumption will recover after conservative treatment. However, there is a high risk of intestinal perforation if intestinal CT reveals the length of rice cake pieces to be 4 cm or longer.

Introduction: Primary care (PC) physicians often struggle with the local dialects of patients, especially when they work away from their hometowns.

Method: We conducted a questionnaire survey of PC physicians in the Hokushinetsu region, the northcentral part of Honshu island of Japan, to understand how doctors recognize and deal with local dialects in their daily clinical practice.

We also analyzed their comments qualitatively using the Steps for Coding and Theorization (SCAT) method.

Results: Thirty-one physicians (21 men and 10 women) completed the questionnaire. Of the total, 71% of respondents worked away from their hometowns.

Moreover, 81.8% of these respondents stated they had difficulties understanding the dialect spoken in the region of their workplaces and 36.3% misunderstood the meanings of the dialect spoken by their local patients as a result. Respondents often heard "ui" or "tekinai" as the chief complaints of local patients, and interpreted these words as physical symptoms such as fatigue, dyspnea, and abdominal distension. SCAT analysis suggested that these words can have different meanings depending on the context. PC physicians translate them into medical terms using paraphrasing techniques based on each patient's medical history. Furthermore, PC physicians use dialects according to their relationship with the patient.

Conclusion: Understanding the characteristics of these dialects and using them appropriately may improve the doctor-patient relationship.