The omission of postoperative chest tube drainage may contribute to early recovery after thoracoscopic major lung resection; however, a validation study is necessary before the dissemination of selective drain policy. 162 patients who underwent thoracoscopic lung resection were enrolled in this study. The chest tube was removed just after the removal of the tracheal tube in selected patients in whom complete pneumostasis was obtained using a combination of bioabsorbable mesh and fibrin glue. The chest tube could be removed in operating room in 102（63%）of all patients. There were no cases of 30-day postoperative mortality or in-hospital death. None of the 102 patients who did not undergo postoperative chest tube placement required re-drainage for subsequent air leak or subcutaneous emphysema. The mean length of postoperative hospitalization was shorter in patients who had not undergone postoperative chest tube placement than in those who had. The omission of chest tube placement was associated with a reduction in the visual analog scale for pain from postoperative day 0 until day 3. The outcome of our validation cohort revealed that no-drain policy is safe in selected patients undergoing thoracoscopic major lung resection and that it may contribute to an early recovery.

The needs of end-of-life care provided at Group Homes（GHs）for older people with dementia are estimated to be increased. We investigated the perspective of doctors and nurses working at a general hospital on providing end-of life care at GHs for future educational activities. We conducted an anonymous self-administered questionnaire with doctors and nurses about their subjective knowledge and perspective of end-of-life care in GHs using several-scale model. A total of 193 doctors and 670 nurses provided valid responses. More than 75% of both doctors and nurses had knowledge on GHs. Doctors’ perspective on end-of-life care were not different depending on their age, gender, length of period as a doctor, and their stand standpoint as a health professional and a family member. They were agreeable to end-of-life care at GHs more than nurses did. Nurses at the age of 40 and over and/or more than 10 years of experience significantly agreed to end-of life care at GHs especially from the standpoint as a family member. This study suggests that practical workshop for medical staff at general hospitals on their possible involvement in end-of-life care at GHs would be effective to promote end-of-life care.

We evaluated the outcome of 141 ears underwent myringoplasty, tympanoplasty, or stapes surgery at Yamaguchi Rosai Hospital between October 2015 and December 2018. The patients’mean age was 34.2 years, with a range of 5-76 years, 67 ears were male（47.5%），and 74 ears were female（52.5%）．Classification of the surgical method showed myringoplasty in 38 ears（27%），tympanoplasty in 93 ears（65.9%），and stapes surgery in 10 ears（7.2%），and the number of myringoplasty was gradually increased. In myringoplasty, 10 ears were performed day surgery with local anesthesia and 28 ears were performed short stay surgery with general anesthesia. Postoperative closure rate of the tympanic membrane perforation was 90.6%. Closure of tympanic membrane perforation was done by myringoplasty or in-lay method. Myringoplasty was adopted for relatively small tympanic membrane perforation and there was no significant difference in closure rate between two groups. The success rate of postoperative hearing improvement was 83.8%. These results were comparable to previous reports, and were thought to be helpful information for preoperative patients.

We offer“Introductory Medicine”for first grade medical students to help them acquire an independent learning method at an early stage of first grade and perform learning as the preliminary stage of professional medical training. In“Introductory Medicine,”students learn medical ethics, professionalism education, and get an early exposure to training. This study aimed to investigate the current situation and upcoming issues in the future of Introductory Medicine. We analyzed the lecture evaluation questionnaire of Introductory Medicine for the past 3 years, wherein the degree of satisfaction, degree of understanding, and degree of achievement of the course have shown significant positive change. Furthermore, we analyzed the secular change of overtime learning time per class, and the proportion of the students who perform overtime learning for less than one hour has temporarily decreased, but is still around 30%；in 2014 the proportion was 18%, and has increased over the past 3 years. We need a continuous learning and analysis approach, through a mentor system, to improve the learning will of the students who lack in it. Additionally, as we integrated sign language this year, we need continuous improvement of lecture contents in Introductory Medicine to equip students to learn independently and from various angles.