Challenging cases of professionalism in Japan: improvement in understanding of professional behaviors among Japanese residents between 2005 and 2013.

BackgroundProfessionalism is deemed as the basis of physicians' contract with society in Japan. Our study in 2005, using a questionnaire with scenarios to professionalism, suggested that many physicians at various levels of training in Japan encounter challenges when responding to these common scenarios related to professionalism. It is unclear how medical professionalism has changed among Japanese residents in over time.MethodsWe conducted a follow-up survey about challenges to professionalism for Japanese residents using the same Barry Questionnaire after a seven-year interval from the prior survey. The survey uses six clinical scenarios with multiple choice responses. The six cases include the following challenges: acceptance of gifts; conflict of interest; confidentiality; physician impairment; sexual harassment; and honesty in documentation. Each scenario is followed by 4 or 5 possible responses, including the "best" and the "second best" responses. The survey was conducted as a part of nationwide general medicine in-training examination.ResultsWe collected data from 1,049 participants (290 women, 28%; 431 PGY-1 and 618 PGY-2 residents). Overall, the current residents performed better than their colleagues in the earlier survey for five scenarios (gifts, conflict of interest, confidentiality, impairment, and honesty) but not for the harassment scenario. PGY-2 residents were more likely to select either the best or 2nd best choices to gifts (p = 0.002) and harassment (p = 0.031) scenarios than PGY-1 residents. Residents in the current study chose either the best or 2nd best choices to the gifts (p < 0.001) and honesty (p < 0.001) scenarios than those of the previous study conducted seven years ago, but not for the harassment scenario (p = 0.004).ConclusionsOur study suggests that there is improvement of medical professionalism with respect to some ethical challenges among the Japanese residents in the current study compared to those in our previous study

Cost-effectiveness of a hybrid emergency room system for severe trauma: a health technology assessment from the perspective of the third-party payer in Japan

Background: Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods: We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2$33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion: The present study suggested that the hybri

Rinsing of oropharynx and storage place of respiratory medicine inhaler: A cross‐sectional audit

BackgroundIn patients with bronchial asthma and those with chronic obstructive pulmonary disease (COPD), inhalation therapy and rinsing of the mouth and the oropharynx by gargling (“RMOG”) after inhalation are recommended. We performed a cross‐sectional audit aimed at investigating (a) the proportion of patients performing “RMOG” after inhalation and (b) storage place of patients’ inhaler.MethodsPatients with bronchial asthma and those with COPD were asked by medical aids at outpatient visits whether they did “RMOG every time,” “RMOG sometimes,” or “no RMOG” after inhalation, and where they stored their inhaler.ResultsDuring a six month study period up to September 2017, 330 consecutive patients with asthma and those with COPD were included in the study. Two hundred and thirty‐two (70.3%) of the 330 patients answered “RMOG every time” and 98 (29.7%) of them did “RMOG sometimes” and did “no RMOG.” There was a difference in the proportion of patients performing RMOG after inhalation with patient age. With regard to the storage location of inhaler, we found the proportion of patients performing RMOG was higher in those who stored inhalers in a room with running water than in those who stored inhalers at other places. This difference was found in patients with both bronchial asthma and those with COPD.ConclusionsFurther implementation of “patient education” on performing RMOG after inhalation for patients receiving inhaled medication is still necessary. Our results suggest that it is better to store inhalers in places where there is easy access to tap water used for RMOG

Über die Wirkung des Chinins auf den Uterus des Menschen und der Tiere

Es wurden vergleichende Versuche betreffs der Chininwirkung einerseits auf den isolierten Uterus des Menschen und verschiedener Tiere, andererseits auf den isolierten und im lebenden Körper befindlichen Uterus bei verschiedenen Tieren angestellt, um die Natur der Wirkung und die klinischen Anwendbarkeit des Chinins näher kennen zu lernen. Die Resultate lassen sich folgendermassen zusammenfassen: 1. Chinin wirkt auf den isolierten Uterus von Hund, Katze, Ratte und Kaninchen in kleineren Dosen fördernd, in grösseren dagegen hemmend. Die erregende Wirkung ist auf die Reizung des Muskels und die hemmende auf die Lähmung desselben zurückzuführen. 2. Auf den Uterus in situ von den genannten Tieren übt Chinin in kleineren Dosen auch eine erregende Wirkung aus. 3. Nach der Untersuchungen am Batten-und Katzenuterus unterscheidet sich der trächtige Uterus hinsichtlich der Wirkungsweise des Chinins von dem nichtträchtigen kaum. Nur ist der erstere an Empfindlichkeit dem letzteren überlegen. 4. Bei den oben genannten Tieren zeigt der Uterus in situ eine analoge Reaktion auf Chinin, wie der isolierte Uterus. 5. Am ausgeschnittenen Menschenuterus weist Chinin in kleineren wie in grösseren Dosen eine hemmende Wirkung auf. Nur auf den schwangeren Uterus wirkt es ab und zu erregend. Die hemmende Wirkung von kleineren Dosen kann auf der Lähmung der fördernden Nervenendigungen des Sympathicus und diejenige von grösseren Dosen auf die des Muskels zurückgeführt werden. Die am schwangeren Uterus auftretende erregende Wirkung scheint auf der Reizung des Muskels zu beruhen. 6. Die Wirkung des Chinins auf den Menschenuterus ist derjenigen auf den Uterus der Tiere im Prinzip gleich, weil es bekannt ist, dass das Gift auch am Uterus der genannten Tiere die fördernden sympathischen Nervenendigungen lähmt und infolgedessen die Wirkung des Adrenalins umkehrt. Nur ist der Erfolginsofern verschieden, als diese Wirkung bei den Tieren normaler Weise erfolglos bleibt und der Erregung des Muskels unterliegt, während sic beim menschlichen Uterus eine Hemmung zur Folge hat

Pharmacological Studies on the Human Fallopian Tube

In the previous papers K. Murakami, one of the authors published the results of his pharmacological researches on human uterus and Lig. teres uteri. The present paper deals with the similar studies on the human Fallopian tube. Human isolated tube produces rhythmical automatism by means of Magnus' method. The automatism of this organ is more frequent but somewhat irregular as compared with those of the uterus or the round ligament of uterus. The tube with its peritoneal cover manifests more irregular automatism than a denuded one, and its peritoneal layer alone produces automatism too. Uterine end of the tube shows more marked automatism than its ovarian end. Ovarial cyst or myoma of uterus do not interfere with the automatism of the Fallopian tube of respective individuals so affected, but careinoma of uterus causes decreased automatism of tube. The difference of ages in patient between 16 and 59 years shows no influence on automatism of this organ, and the Status of wether multiparous or nulliparous has no factor in this respect. Adrenalin in low concentration manifests a stimulative action on the tube, while in high concentration it produces stimulative effect in most cases, but sometimes depressive action. This fact suggests us that the sympathetic nerve of this organ has both motor and inhibitory functions. A smoll dose of pilocarpin produces a stimulative action on the tube. The same reaction is recognized in the experiment with acetylcholin. So, it is clearly understood that the parasympathetic nerve in this organ is motor in its function. But pilocarpin in high concentration stimulate the sympathetic inhibitor while acetylcholin in high concentration paralyzes the muscle of the tube, both causing the depressing effect on the automatism of the organ. Physostigmin manifests stimulative effect on the human tube, acting mainly on its muscle. Its action on the parasympathetic nerve can hardly be proved. Atropin shows very inconsistent effect on the tube, but in low concentration, it paralizes parasympathetic nerve, while motor sympathetic nerve is affected by its moderately concentrated solution. Pituitrin acts as inhibitory on the tube by affecting the inhibitory sympathetic nerve. Secacornin in low concentration manifests stimulative action on the tube by affecting muscle, while in high concentration, it causes the depression of automatism by acting on inhibitory fibre of the sympathetic nerve. Barium affects the muscle of the tube and stimulative action is recognized. As it has been mentioned above, actions of adrenalin, pilocarpin, acetylcholin, physostigmin, atropin and barium on the human tube do not vary from the some on the uterus and round ligament, while pituitrin and secacornin show somewhat different actions on those organs