モギ シケン セイセキ ト ヒューマン エラー ハッセイ スウ トノ カンケイ ニ ツイテ

試験におけるエラーの発生予防策を立案して実践する上では,エラーを頻回におかす学生を早期に発見して,重点的に介入する必要がある.そこで,学生の試験成績とヒューマンエラー発生との関係を明らかにした.対象は医学部6 年生102 人が受験した医師国家試験模擬試験結果である.自己採点結果と,マークシートによる機械的採点結果をもとに予期せぬ失点の原因を調べた.また,試験成績とエラー発生頻度との関係を調べた.ヒューマンエラー発生の有無によって,試験成績に有意な差はなかった.しかし,400 問あたり3 問以上のエラーをおかす受験生の得点率は61.4±6.1%であり,2 問以下のエラーをおかす受験生の得点率(65.6±5.3%)に比べて有意に低かった.成績上位者を含めた全ての受験生にエラーが生じ得るため,全学年を対象とした注意喚起が必要と思われる.また,成績下位者には多数のエラーをおかす学生が多くみられることから,これらの学生を対象とした重点的な教育介入が求められる.To examine the relationship between the occurrence ofinadvertent human errors and examination scores, the resultsof the trial examination were analyzed. The 102 of 6thgrade medical students took the trial examination for theNational Examination for Physicians\u27 which consist of 500multiple-choice questions. More than half of the students(52.9 %) made inadvertent errors during the examination.Two-third of errors were either selecting the wrong numberof answer options( i.e. when a two choice selection wasrequired, only one choice was selected).There was no significant relationship between the occurrenceof inadvertent human errors and their scores. However,the mean score of the students who made more thantwo errors in 400 questions was 61.4±6.1%, significantlylower than those of other students( 65.6±5.3%). Attentionto avoid the inadvertent human errors during the examinationmight be emphasized for all students. Furthermore, theintervention to reduce the inadvertent human errors is especiallyneeded for the students with low scores

シケン ニオケル ヒューマン エラー ノ ヨボウ タイサク ニ ツイテ

試験におけるヒューマンエラーの実態を明らかにし,予防教育の効果を検証するために,医師国家試験模擬試験を利用して受験生がおかすヒューマンエラーを包括的に調査解析した.医学部6年生が2回の医師国家試験模擬試験を受験し,自己採点結果と,マークシートによる機械的採点結果を対比した.2回の試験を通じて,受験生1人が1回の試験で平均1.4個のエラーをおかしていた.エラーの分類別頻度では,2肢選択すべきところを1肢しか選択しなかったエラーが49.1%,1肢選択すべきところを2肢以上選択したエラーが31.6%,選択したものと異なる記号をマークしたエラーが10.5%と続いた.全ての受験者(全受験者)と,2回の試験に参加した受験者(2回受験者)に大別してエラーの発生頻度,エラーの内容について比較した.2 回受験者は,1人当たりがおかすエラー数および2問以上のエラーをおかす人の割合ともに2回目の試験で有意に減少していた. これは,受験者自らがエラーの実態に気付き,そして適切な助言のもとに注意を払って試験に臨んだ結果と思われる.試験におけるヒューマンエラーの実態を明らかにし,それを最小限にくい止める対策は,単に医師国家試験における失点防止だけでなく,ミスをおかしてもそれに気付き,問題解決ができるようなerror tolerantの考え方を養う上でも重要と思われる.We analyzed inadvertent human errors made by 6thgrade medical students during two trial examinations madeup of 500 multiple-choice questions where either one or twocorrect answers were required. Forty and 39 students, respectively,took the two examinations. Students averaged1.4 errors each during the examinations. Most errors( 80.7%) involved selecting the wrong number among the answeroptions( i.e. when a two option selection was required,only one option was selected). The students who had takenboth examinations made significantly less errors in the latterexamination than the former. Furthermore, the prevalenceof students who had made more than one inadvertenterror was significantly lower among students who tookboth examinations. We showed the effectiveness of interventionregarding inadvertent errors during 500 multiplechoicequestion examinations and of educating the studentsabout preventive measures. These results might have auseful application to improved safety promotions based onerror-tolerant theories

The burden of disease and injury in Iran 2003

<p>Abstract</p> <p>Background</p> <p>The objective of this study was to estimate the burden of disease and injury in Iran for the year 2003, using Disability-Adjusted Life Years (DALYs) at the national level and for six selected provinces.</p> <p>Methods</p> <p>Methods developed by the World Health Organization for National Burden of Disease (NBD) studies were applied to estimate disease and injury incidence for the calculation of Years of Life Lost due to premature mortality (YLL), Years Lived with Disability (YLD), and DALYs. The following adjustments of the NBD methodology were made in this study: a revised list with 213 disease and injury causes, development of new and more specific disease modeling templates for cancers and injuries, and adjustment for dependent comorbidity. We compared the results with World Health Organization (WHO) estimates for Eastern Mediterranean Region, sub-region B in 2002.</p> <p>Results</p> <p>We estimated that in the year 2003, there were 21,572 DALYs due to all diseases and injuries per 100,000 Iranian people of all ages and both sexes. From this total number of DALYs, 62% were due to disability premature deaths (YLD) and 38% were due to premature deaths (YLL); 58% were due to noncommunicable diseases, 28% – to injuries, and 14% – to communicable, maternal, perinatal, and nutritional conditions. Fifty-three percent of the total number of 14.349 million DALYs in Iran were in males, with 36.5% of the total due to intentional and unintentional injuries, 15% due to mental and behavioral disorders, and 10% due to circulatory system diseases; and 47% of DALYs were in females, with 18% of the total due to mental and behavioral disorders, 18% due to intentional and unintentional injuries, and 12% due to circulatory system diseases. The disease and injury causes leading to the highest number of DALYs in males were road traffic accidents (1.071 million), natural disasters (548 thousand), opioid use (510 thousand), and ischemic heart disease (434 thousand). The leading causes of DALYs in females were ischemic heart disease (438 thousand), major depressive disorder (420 thousand), natural disasters (419 thousand), and road traffic accidents (235 thousand). The burden of disease at the province level showed marked variability. DALY estimates by Iran's NBD study were higher than those for EMR-B by WHO.</p> <p>Conclusion</p> <p>The health and disease profile in Iran has made the transition from the dominance of communicable diseases to that of noncommunicable diseases and road traffic injuries. NBD results are to be used in health program planning, research, and resource allocation and generation policies and practices.</p

ホンガク ドウソウ カイイン ノ キンム ジョウキョウ : ジョセイ イシ シエン オ メザス ヨビテキ ケンキュウ トシテ

雇用の分野における男女の均等な機会及び待遇の確保のために,「男女雇用機会均等法」が成立し,妊娠や出産を理由として職場で不利益な取り扱いをすることは禁じられている1).さらに,「男女共同参画社会基本法」が施行され,2006 年には日本医師会に男女共同参画委員会が設立している2).しかし,我が国の女性医師の就労に影響を与える因子を検討した先行研究によると,性差による就労上の不利益を経験した女性医師が多く,就労格差を女性医師は強く認識しているという結論となっている3).このことは日本ばかりではなく,海外でも同様に報告されている4,5).特に,女性医師は男性医師に比較して,非常勤パートタイムで勤務することが多いと報告されている3,4).パートタイムで働く主たる理由は,出産と子育てである5).多くの女性医師が子育てを優先するために仕方なくパートタイム勤務を選択していることは事実である.また,母性を優先させる選択は職場での昇進・キャリアアップを閉ざすという結果につながる 3).しかし,一方で女性にとって出産や育児は非常に大切な母性の獲得であり,出産を経験した女性医師は医師を職業として選択したことにより満足していると報告されている6).これが女性医師にとってのワーク・ライフ・バランスのジレンマになっている.さらに,現在,医師を養成する大学医学部では,男女は平等に入学できるが,過酷な労働を強いられる大学病院では,女性医師は常勤勤務から離職せざるを得なくなるというアンバランスが生じている.本研究は,本学の女性医師支援のあり方を考える予備的研究として,本学同窓会会員の現況報告を検討し,さらに女性医師支援に関する先行文献を考察することを目的とした

チイキ ホウカツ イリョウ ジッシュウ ノ ジュコウセイ ノ トクセイ ト ソノ キョウイク コウカ ニ カンスル ケンキュウ

全国的に地域枠入学者による医学部定員増加が行われている.それに伴い医学部では,より良い地域医療教育の導入が求められている.そこで本研究は,地域医療を目指す学生の特性を知るとともに地域医療教育の効果を学生の自己評価点とSOC (Sense of Coherence) 得点の地域教育導入前後比較により検討することを目的とした.調査対象は,獨協医科大学医学部第1学年おける地域包括医療実習受講生の16名( 男子9名,女子7名:平均年齢18.9±1.0歳) と非受講生の1年生98名( 男子66名,女子32名:平均年齢19.9±1.7歳) である.平成22 年7 月15 日に対象者全員に対して研究の説明を行い,文書による研究参加への同意を得た後,行動規範26項目の自己評価 (7 点満点) とSense of Coherence (SOC) 29 項目及び生活習慣に関する質問12 項目に回答する自記式アンケート調査を行った.さらに,平成22 年12 月11 日に,受講生のみを対象に7 月15 日に施行したものと同一のアンケート調査を行った.地域包括医療実習I 受講生は,非受講生に比較して,家族と同居しているもの,現在運動をしていないものが多かった.また,学習態度の自己評価点とSOC 処理可能感の得点が有意に高かった.地域包括医療実習I の実習前後の変化を検討したところ,生活態度の自己評価が終了時には有意に上昇していた.しかしSOC 把握可能感の得点が有意に低下していた.地域医療教育導入前後でほとんどの項目で大きな変化はなかったが,生活態度の行動変容に良い効果が得られた.また,把握可能感が低下していたため,面接などで適切な支援が必要である.The quotas of students who wish to be involved in communitymedicine have increased in medical schools in Japan.Accordingly, programs focused on community medicineare required in medical education. In this study weaimed to identify the characteristics of medical studentswho pursue community medicine. We also aimed to evaluatethe effects of the local community medical educationcourse for medical students by examining changes in thescores of self-evaluation of standards of conduct and in thescores of sense of coherence (SOC) before and after thecourse.Participants were 16 first-year students (9 men, 7 women;mean age, 18.9±1.0 years) at Dokkyo Medical Universitywho took the comprehensive community medicinepractice course( community medicine course students) and98 students (66 men, 32 women;mean age, 19.9±1.7years) who did not take the course( non-community medicinecourse students).Information on the study was provided on July 15, 2010,and written informed consent was obtained from all participants.A self-evaluation questionnaire comprising 26 itemsregarding standards of conduct, each to be rated on a seven-point scale, and a questionnaire comprising 29 items ofSOC and 12 items of lifestyle were used. Both questionnaireswere completed by all participants on July 15, 2010and by the community medicine course students on DecemberThe percentage of students who lived with their familiesand the percentage of students who did not regularly exerciseat the time of the questionnaire survey were higher inthe community medicine course students than in the noncommunitymedicine course students. In addition, the selfevaluationscore for attitude toward leaning and the SOCscore for sense of manageability were significantly higher inthe community medicine course students than in the noncommunitymedicine course students. In the communitymedicine course students, the self-evaluation score for attitudetoward life was significantly increased, while the SOCscore for sense of comprehensibility significantly decreasedby the end of the course.The comprehensive community medicine practice coursehad a positive effect on student attitude toward life, andpreferable behavioral modifications were observed, althoughscores for most items remained unchanged by the end ofthe course. Our findings revealed a decrease in sense ofcomprehensibility, indicating that appropriate student support,such as consultation, is necessary

イガクセイ トシテ テキセツ ナ コウドウ ヤ タイド オ ジコ ヒョウカ スル トキニ エイキョウ スル セイカツ シュウカン カンレン インシ ノ ケントウ : ダイ1ガクネン カラ ダイ2ガクネン エノ ジコ ヒョウカ テン ノ ヘンカ オ チュウシン ニ

目的:プロフェッショナリズムの育成を医学教育に導入することを前提に医学生の低学年時の行動に対する自己評価の変化とそれに影響する因子を検討した.調査対象:2010 年の獨協医科大学医学部第1 学年の学生92 名(男子57 名,女子35 名)調査方法:2010 年7 月の1 年次と2011 年8 月に2 年次の2 回にわたって行動規範に関する自己評価表および国民健康・栄養調査に基づき作成した生活習慣調査アンケート調査を施行したその得点に影響する生活習慣関連因子を検討した.結果:1 年次から2 年次で自己評価が有意に向上したのは,「他者の人権や人格を尊重し,積極的かつ友好的にコミュニケーションをとり,分かりやすく説明する技術や態度の習得」「常に予習・復習を欠かさないなど学習習慣」「積極的に新しい知識や技能を吸収しようとする能動的な学習態度」であった.一方,2 年次で有意に自己評価が低下していたのは「講義や実習を欠席しない」「他人のものを盗用したり,データをねつ造したりしてレポートを作成しない」「与えられた課題や宿題等の提出期限を守っている」などであった.1 年次の低い自己評価に影響した項目は,男子,喫煙経験,朝食欠食,睡眠で休養がとれていないこと,睡眠補助剤の使用であった.さらに,1 年次の喫煙経験は2 年次の低い自己評価にも影響した.結論:不健康なライフスタイルが行動や態度の自己評価に影響することが判明したことより,生活習慣の変容は,行動の自己評価を向上させる可能性が示唆された.ObjectiveThe purpose of this study was to investigate factors associatedwith the professionalism of medical students, andspecifically their fitness to practice.SubjectsSubjects were 92 first-year students (57 men, 35 women)at Dokkyo Medical University School of Medicine.MethodsA 26-item self-report questionnaire on fitness to practiceand a 12-item self-report questionnaire on lifestyle werecompleted by the medical students at Dokkyo Medical University,once in their first year in July 2010 and again intheir second year in August 2011.ResultsFitness to practice scores were significantly higheramong second-year than first-year students regarding"friendly and positive communication with others while respectingtheir individual differences and human rights","learning earnestly through preparation and review beforeand after lectures", and "willingness to learn". Conversely,fitness to practice scores were significantly lower amongthe second-year than first-year students regarding "unexcusedabsence from lectures or clinical practice"," submissionof plagiarized or falsified reports", and" missed submissiondeadlines". The factors associated with lower selfassessmentscores among first-year students were beingmale, smoking experience, skipping breakfast, poor qualityof sleeping and sleeping pill usage. Furthermore, smokingexperience among first-year students was associated withlower self-assessment scores of fitness to practice in thesecond year.ConclusionThe results suggest that the early adoption of healthybehaviors had a positive influence on fostering educationalprofessionalism among medical student

Community pharmacy teams’ experiences of general practice-based pharmacists: an exploratory qualitative study

Background: In England, since 2015, there has been a formal drive to integrate pharmacists into general practice as a new healthcare service. Research efforts have offered insights into how general practice-based professionals and patients view the service, however, they took no account of community pharmacy teams’ opinions. There have been anecdotal statements about opposition from community pharmacies to the service, due to fears of losing business. The aim of the current study was to identify the experiences and perceptions of community pharmacy teams regarding pharmacists’ presence in general practice. Methods: The National Health Service Choices website was used to identify community pharmacies within a radius of two miles from eight West London general practices. The search resulted in 104 community pharmacies which were all contacted via telephone. Pharmacy staff who verbally expressed their interest to participate were then provided with the study’s documents. Qualitative, face-to-face, semi-structured interviews were conducted inside the pharmacy from which each participant was recruited. Interviews lasted 30 to 45 minutes and were audio-recorded. Audio-recordings were transcribed verbatim and transcripts analysed thematically. Results: Forty-eight community pharmacy staff participated. Four themes were discerned: awareness (“I knew that [pharmacists] have already been implemented [in general practice] but I haven’t really followed it…where does the pharmacist role come?”); interactions (“I’m just so pleased that there’s a pharmacist professional in the general practice…because we speak the same language!”); patient care (“if I was a patient knowing that there is a general practitioner and a pharmacist [in general practice], I would…think ‘nothing can go wrong at the moment’”); and funding challenges (“if general practices take on the extra responsibility of stop smoking or flu vaccination campaigns…financially, this would affect this pharmacy”). Conclusions: The current study revealed the perceived impact of general practice-based pharmacists on community pharmacies would be improved communication between pharmacies and practices. Findings will inform policy so that any future framing of pharmacists’ presence in general practice considers the needs of community pharmacies

How do pharmacists in English general practices identify their impact? An exploratory qualitative study of measurement problems

Background: In England, there is an ongoing national pilot to expand pharmacists’ presence in general practice. Evaluation of the pilot includes numerical and survey-based Key Performance Indicators (KPIs) and requires pharmacists to electronically record their activities, possibly by using activity codes. At the time of the study (2016), no national evaluation of pharmacists’ impact in this environment had been formally announced. The aim of this qualitative study was to identify problems that English pharmacists face when measuring and recording their impact in general practice. Methods: All pharmacists, general practitioners (GPs) and practice managers working across two West London pilot sites were invited, via e-mail, to participate in a focus group study. Appropriately trained facilitators conducted two audio-recorded, semi-structured focus groups, each lasting approximately one hour, to explore experiences and perceptions associated with the KPIs. Audio-recordings were transcribed verbatim and the data analysed thematically. Results: In total, 13 pharmacists, one GP and one practice manager took part in the study. Four major themes were discerned: inappropriateness of the numerical national KPIs (“whether or not we actually have positive impact on KPIs is beyond our control”); depth and breadth of pharmacists’ activity (“we see a huge plethora of different patients and go through this holistic approach - everything is looked at”); awareness of practice based pharmacists’ roles (“I think the really important [thing] is that everyone knows what pharmacists in general practice are doing”); and central evaluation versus local initiatives (“the KPIs will be measured by National Health Service England regardless of what we think” versus “what I think is more pertinent, are there some local things we’re going to measure?”). Conclusions: Measures that will effectively capture pharmacists’ impact in general practice should be developed, along with a set of codes reflecting the whole spectrum of pharmacists’ activities. Our study also points out the significance of a transparent, robust national evaluation, including exploring the needs/expectations of practice staff and patients regarding pharmacists’ presence in general practice

A prospective, double-blind, randomized, controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care only for the treatment of chronic, non-healing ulcers of the lower limb in patients with diabetes mellitus: a study protocol

<p>Abstract</p> <p>Background</p> <p>It has been suggested that the use of adjunctive hyperbaric oxygen therapy improves the healing of diabetic foot ulcers, and decreases the risk of lower extremity amputations. A limited number of studies have used a double blind approach to evaluate the efficacy of hyperbaric oxygen therapy in the treatment of diabetic ulcers. The primary aim of this study is to assess the efficacy of hyperbaric oxygen therapy plus standard wound care compared with standard wound care alone in preventing the need for major amputation in patients with diabetes mellitus and chronic ulcers of the lower limb.</p> <p>Methods/Design</p> <p>One hundred and eighteen (59 patients per arm) patients with non-healing diabetic ulcers of the lower limb, referred to the Judy Dan Research and Treatment Centre are being recruited if they are at least 18 years of age, have either Type 1 or 2 diabetes with a Wagner grading of foot lesions 2, 3 or 4 on lower limb not healing for at least 4 weeks. Patients receive hyperbaric oxygen therapy every day for 6 weeks during the treatment phase and are provided ongoing wound care and weekly assessments. Patients are required to return to the study centre every week for an additional 6 weeks of follow-up for wound evaluation and management. The primary outcome is freedom from having, or meeting the criteria for, a major amputation (below knee amputation, or metatarsal level) up to 12 weeks after randomization. The decision to amputate is made by a vascular surgeon. Other outcomes include wound healing, effectiveness, safety, healthcare resource utilization, quality of life, and cost-effectiveness. The study will run for a total of about 3 years.</p> <p>Discussion</p> <p>The results of this study will provide detailed information on the efficacy of hyperbaric oxygen therapy for the treatment of non-healing ulcers of the lower limb. This will be the first double-blind randomized controlled trial for this health technology which evaluates the efficacy of hyperbaric oxygen therapy in prevention of amputations in diabetic patients.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00621608">NCT00621608</a></p

Expenditures for the care of HIV-infected patients in rural areas in China's antiretroviral therapy programs

<p>Abstract</p> <p>Background</p> <p>The Chinese government has provided health services to those infected by the human immunodeficiency virus (HIV) under the acquired immunodeficiency syndrome (AIDS) care policy since 2003. Detailed research on the actual expenditures and costs for providing care to patients with AIDS is needed for future financial planning of AIDS health care services and possible reform of HIV/AIDS-related policy. The purpose of the current study was to determine the actual expenditures and factors influencing costs for untreated AIDS patients in a rural area of China after initiating highly active antiretroviral therapy (HAART) under the national Free Care Program (China CARES).</p> <p>Methods</p> <p>A retrospective cohort study was conducted in Yunnan and Shanxi Provinces, where HAART and all medical care are provided free to HIV-positive patients. Health expenditures and costs in the first treatment year were collected from medical records and prescriptions at local hospitals between January and June 2007. Multivariate linear regression was used to determine the factors associated with the actual expenditures in the first antiretroviral (ARV) treatment year.</p> <p>Results</p> <p>Five ARV regimens are commonly used in China CARES: zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP), stavudine (D4T) + 3TC + efavirenz (EFV), D4T + 3TC + NVP, didanosine (DDI) + 3TC + NVP and combivir + EFV. The mean annual expenditure per person for ARV medications was US$2,242 (US$1 = 7 Chinese Yuan (CNY)) among 276 participants. The total costs for treating all adverse drug events (ADEs) and opportunistic infections (OIs) were US$29,703 and US$23,031, respectively. The expenses for treatment of peripheral neuritis and cytomegalovirus (CMV) infections were the highest among those patients with ADEs and OIs, respectively. On the basis of multivariate linear regression, CD4 cell counts (100-199 cells/μL versus <100 cells/μL, <it>P </it>= 0.02; and ≥200 cells/μL versus <100 cells/μL, <it>P </it>< 0.004), residence in Mangshi County (<it>P </it>< 0.0001), ADEs (<it>P </it>= 0.04) and OIs (<it>P </it>= 0.02) were significantly associated with total expenditures in the first ARV treatment year.</p> <p>Conclusions</p> <p>This is the first study to determine the actual costs of HIV treatment in rural areas of China. Costs for ARV drugs represented the major portion of HIV medical expenditures. Initiating HAART in patients with higher CD4 cell count levels is likely to reduce treatment expenses for ADEs and OIs in patients with AIDS.</p