Introduction: This study evaluated the effectiveness of co-management of the neurosurgery department by general physicians.

Methods: A retrospective observational study was conducted in a tertiary hospital. Length of stay, in-hospital mortality, number of transfers to the intensive care unit (ICU) due to emergency medical problems, prescription sharing ratio with neurosurgeon, and impression reported by nurses were evaluated by comparing one year before and after the co-management of the neurosurgery department was initiated.

Results: Length of stay (Median 14 days, 14 days), mortality rate (7.58%, 5.75%) and transfer rate for ICU (3.23%, 1.94%) were not significantly different between one year before and one year after, respectively. Subgroup analysis of patients over 70 years of age hospitalized for cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage showed that the number of patients transferred to the ICU due to medical problems associated with internal medicine significantly decreased (P = 0.04). A general physician was responsible for half of the prescriptions. The nurse's report was highly positive.

Conclusion: Co-management of the neurosurgery department by general physicians did not have a significant effect on reducing length of stay or mortality rate; however, we found a decrease in the number of patients transferred to the ICU due to medical problems among elderly stroke patients.

Introduction: The career support system was introduced in Okayama University Hospital in 2008, and the number of users has exceeded 150. Methods: To examine changes in perceptions of the system and its users, we conducted a questionnaire survey of supervisors and the colleagues of system users in FY2011 and FY2018. Results: Compared to 2011, the following items were significantly higher in FY2018: "I have experience working with users of the support system", "I think this system is useful for the medical office", and "This system makes the medical office more appealing". In the analysis of the colleagues of system users only, in addition to the aforementioned three items, the item "Users of the system are able to do their jobs to the degree expected" was significantly higher in FY2018. Conclusion: The effectiveness of the career support system is becoming more recognized, and the evaluation of the work content of the system's users has improved.

We examined ambulatory clinical training for patients with dementia conducted by residents at a university hospital and instructors at a psychiatric hospital who mainly treat patients with dementia in the General Internal Medicine Department of a regional hospital. Residents experienced dementia treatment in the context of primary care, and performed in-depth learning about dementia with the guidance of psychiatrists. It is hoped that dementia treatment will be provided by family doctors. Moreover, it is expected that doctors who have undergone this training will contribute to dementia treatment.

We have conducted driving fitness evaluations for post-illness patients in our clinic since 2008. Many patients expressed a desire to resume driving; thus, primary care physicians and rehabilitation staff collaborated to establish an evaluation system. We conducted cognitive dysfunction evaluation, driving simulator evaluation, and evaluation at driving schools. Among 160 patients, we evaluated 87 to be fit to drive, and eight to be unfit. We describe the significance and challenges of assessing patients' driving aptitude in primary care.