Factors Affecting the Gait Ability of the Home-bound Stroke Patients

Mediologische Lektüre von Friedrich Schillers Drama "Maria Stuart

Retention rate of physicians in public health administration agencies and their career paths in Japan

<p>Abstract</p> <p>Background</p> <p>Physicians who serve as public health specialists at public health centers and health departments in local or central government have significant roles because of their public health expertise. The aim of this study is to analyze the retention and career paths of such specialists in Japan.</p> <p>Method</p> <p>We analyzed the data of seven consecutive surveys, spanning 1994 to 2006. We first analyzed the 2006 survey data by sex, age group, and facility type. We then examined the changes over time in the proportion of physicians working in public health administration agencies. We also examined the distribution of the facility types and specialties in which physicians worked both before beginning and after leaving their jobs. These analyses were performed by using physician registration numbers to cross-link data from two consecutive surveys.</p> <p>Results</p> <p>The proportion of physicians working in public health administration agencies was 0.7% in 2006. The actual numbers for each survey ranged between 1,800 and 1,900. The overall rate remaining in public health administration agencies during the two-year survey interval was 72.8% for 1994-1996. The ratio declined to 67.2% for 2004-2006. Among younger physicians with 1-10 years of experience, the retention rate showed a sharp decline, dropping from 72.6% to 50.0%. Many of these physicians came from or left for a hospital position, with the proportion entering academic hospital institutions increasing in recent years. In many cases, physicians left or entered internal medicine clinical practices.</p> <p>Conclusion</p> <p>At present in Japan, the number of physicians who leave and the number who begin a position are almost the same; thus, some of the problems associated with physicians leaving are yet to become apparent. However, the fact that the retention period is shortening for younger physicians may represent a future problem for ensuring the quality of physicians in public health administration agencies. Possible strategies include: increasing the number of physicians entering positions; reducing the number leaving positions; and creating a system where physicians can easily reenter positions after leaving while also establishing a revolving door type of career development system, involving both public health departments and hospital clinical departments.</p

The distribution and transitions of physicians in Japan: a 1974–2004 retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>In Japan, physicians freely choose their specialty and workplace, because to date there is no management system to ensure a balanced distribution of physicians. Physicians in Japan start their careers in hospitals, then become specialists, and then gradually leave hospitals to work in private clinics and take on primary care roles in their specialty fields. The present study aimed to analyse national trends in the distribution and career transitions of physicians among types of facilities and specialties over a 30-year period.</p> <p>Methods</p> <p>We obtained an electronic file containing physician registration data from the Survey of Physicians, Dentists and Pharmacists. Descriptive statistics and data on movement between facilities (hospitals and clinics) for all physicians from 1974, 1984, 1994 and 2004 were analysed. Descriptive statistics for the groups of physicians who graduated in 1970, 1980 and 1990 were also analysed, and we examined these groups over time to evaluate their changes of occupation and specialty.</p> <p>Results</p> <p>The number of physicians per 100 000 population was 113 in 1974, and rose to 212 by 2004. The number of physicians working in hospitals increased more than threefold. In Japan, while almost all physicians choose hospital-based positions at the beginning of their career, around 20% of physicians withdrew from hospitals within 10 years, and this trend of leaving hospitals was similar among generations. Physicians who graduated in 1980 and registered in general surgery, cardiovascular surgery or paediatric surgery were 10 times more likely to change their specialty, compared with those who registered in internal medicine. More than half of the physicians who registered in 1970 had changed their specialties within a period of 30 years.</p> <p>Conclusion</p> <p>The government should focus primarily on changing the physician fee schedule, with careful consideration of the balance between office-based physicians and hospital-based physicians and among specialties. To implement effective policies in managing health care human resources, policy-makers should also pay attention to continuously monitoring physicians' practising status and career motivations; and national consensus is needed regarding the number of physicians required in each type of facility and specialty as well as region.</p

サイセンタン ノ サンジゲン イメージング システム : シンゾウ ケッカン ゲカ ニオケル Virtual Reality ギジュツ ノ ユウヨウセイ

滋賀医科大学心臓血管外科では医療用画像を三次元構築し、臓器を立体表示するVirtual Reality (VR) 技術を用いて心臓血管系の3D解析研究を進めている。VRでは臓器の内腔を可視化することができ、また3D構築した画像に直接介入し、従来の2D解析では評価困難であった複雑な構造も術者の視点で直観的に計測できるという利点がある。あらゆる医療画像データを三次元化し, かつ直感的な立体計測が可能なVR技術は, これまでの診断精度を上回る形態学的な情報を臨床医に提示し得ると考えられる。特に外科医にとって有用な手術支援VR画像は, 難易度が高い手術の治療成績を向上させる可能性が高い。Adequate preoperative planning may facilitate successful procedures in cardiovascular surgery. We have newly developed a system the Vesalius 3D suite, combining three-dimensional (3D) image-processing software with an optic-tracking spatial navigation, allowing quick, accessible 3D image interpretation for virtual reality (VR) exploration and measurement of complex anatomy. In this review, we present a novel method of virtual imaging analysis for preoperative planning and simulation in cardiovascular operation using this 3D-VR system. Based on unimodal or multimodal medical imaging data, DICOM data sets can be reconstructed for 3D visualization. Virtually reconstructed images can be viewed on stereoscopic 3D display, revealing each patient’s specific anatomy and the internal structures in exquisite detail. Highly accessible 3D interpretation promptly permits precise and intuitive measurements of repair-relevant anatomical parameters including geometrically complex shapes. This technology may promote understanding of form and function in the cardiovascular system, and facilitate operative procedures in more challenging cases. Furthermore, this system can be especially valuable for any surgeon to gain experience in practicing for rarely-performed procedures or uncommon patient-specific preoperative surgical simulations