Introduction: This study aimed to identify the characteristics of home healthcare activities in Kyoto by administering a questionnaire survey to community pharmacists.

Methods: We mailed participation request letters to 411 pharmacies belonging to the Kyoto Pharmaceutical Association that performed home healthcare. The importance level, implementation level, and customer satisfaction (CS) of participating pharmacies were analyzed.

Results: Of the 30 items in home healthcare services provided by pharmacists, the following were considered highly important but less frequently implemented, with no correlation: item 4) dispensing medications using the suspension method according to the patient's condition, item 5) dispensing narcotics, item 6) assisting with the administration of enteral and nasal medications, item 26) cooperating and sharing information with dentists or dental hygienists, and item 30) participating in discharge conferences. These items were identified as primary areas needing improvement in the CS analysis.

Conclusion: In home healthcare, tasks performed by community pharmacists focused on the explanation and management of medicines; however, they did not often carry out interpersonal tasks such as interprofessional work and confirmation of medical conditions and side effects.

Introduction: Primary care includes general outpatient clinics and primary/secondary emergency outpatient clinics; however, the differences in treatment settings between these clinics may affect the development of educational programs for postgraduate clinical training. This study aimed to retrospectively investigate the content experienced by residents in community-based outpatient training, which includes general ambulatory training and primary/secondary emergency training, and to compare the differences between items that are more likely to be experienced in general outpatient clinics and those that are more likely to be experienced in the emergency department.

Methods: The number of trainees who experienced symptoms and diseases specified in the national residency system was calculated during general ambulatory training and primary emergency training. These numbers were compared by the Fisher's exact test.

Results: Items suitable for learning clinical reasoning, such as headache, and items suitable for continuous treatment of chronic diseases, such as dementia, were experienced significantly more frequently in general ambulatory training than emergency training.

Conclusion: The symptoms and diseases that are likely to be experienced in general ambulatory training were extracted. These items were considered to be consistent with the purpose of general outpatient training.

A 63-year-old man with schizophrenia presented to our hospital with a chief complaint of anorexia and edema in the lower legs for the past month. Upper gastrointestinal endoscopy revealed a gross type 3 gastric carcinoma (pathology: tubular adenocarcinoma, moderately differentiated type) from the upper gastric body to the gastric antrum. His serum total protein level was 4.7 g/dL and serum albumin concentration was 1.5 g/dL. Contrast-enhanced computed tomography, magnetic resonance imaging, and examination of ascites showed no evidence of distant metastases. Hypoalbuminemia was refractory to albumin administration with no evidence of cancerous peritonitis on staging laparoscopy. Gastrointestinal scintigraphy confirmed protein leakage from the gastric tumor into the gastrointestinal tract. We reviewed the literature and identified 34 other cases of protein-losing gastric cancer, which were used to comprehensively elucidate its clinical features. Borrmann type 0 or 1 tumors of the gastric body or antecubital area, with a maximum tumor diameter of nearly 10 cm and a cauliflower-like appearance, are highly suggestive of protein-losing gastric cancer. In conclusion, ^99mTc-HSA scintigraphy and staging laparoscopy should be performed aggressively to differentiate protein-losing gastric cancer tumor from cancerous peritonitis.

A 71-year-old woman with normal renal function one month prior to presentation was diagnosed with shingles on her right thigh and received valacyclovir (VACV 3,000 mg/day). She was subsequently admitted to the hospital for evaluation of renal dysfunction and impaired consciousness. Acyclovir (ACV) neurotoxicity was suspected, and VACV was discontinued with initiation of continuous renal replacement therapy. Her symptoms resolved. Blood tests revealed a blood ACV level of 57.5 μg/mL. The patient was diagnosed with ACV neurotoxicity based on her clinical course. Clinicians should be mindful that renal dysfunction and ACV neurotoxicity may occur even in patients with normal renal function before treatment. Among all reported cases of ACV neurotoxicity in patients with normal renal function before VACV administration, 9 of 10 patients were aged > 65 years. Thus, these studies support our findings that elderly patients warrant special attention. ACV neurotoxicity symptoms are nonspecific but may improve with early diagnosis and drug discontinuation. The incidence of shingles is increasing in recent years, and the number of VACV prescriptions in primary care is expected to increase. Primary care physicians should be familiar with ACV neurotoxicity to ensure the prompt diagnosis of this condition.

The Preventive Home Visit Practicum is a nursing training program where students, grouped in teams of four or five (comprising a freshman, sophomore, junior, and senior), regularly visit a community-dwelling older adult. Due to the COVID-19 pandemic, the practicum was conducted with various infection control measures, and alternative activities were attempted when home visits were suspended. The experience of responding to the pandemic highlighted the importance of this practicum, which transcends the school year and underscores the necessity of cooperation of the community.

General practitioners frequently encounter uncertainties, making it an urgent issue to address. Recently, there has been growing attention to the concept of negative capability, which is the ability to remain in a state of uncertainty, mystery, and doubt without feeling a need to search for facts or apply reason. The Negative Capability Conference aims to encourage general practioner to recognize and accept uncertainty, acknowledging the various emotions involved in the process.

"Brain fog" is a symptom of long COVID. Brain fog is suspected to be a neurocognitive dysfunction; however, the underlying pathology remains to be elucidated. To provide better medical care for patients with "brain fog", we collaborated with a hospital outpatient department that specializes in the assessment and treatment of cognitive impairment. For the establishment of the collaborative system, we devised a questionnaire for "brain fog" based on medical reports, internet resources, and clinical experiments to be used as a screening tool. The questionnaire was used to calculate a "brain fog score" (BFS). A BFS of more than 5 points was established as the criterion for patient referral. The present retrospective evaluation suggests that BFS is useful for predicting prognosis and prioritizing patients within limited outpatient appointment slots.