PubMed | Juntendo University, The Good, University of Tsukuba, Tokyo Joto Hospital and 3 more.
Type: | Journal: International journal of general medicine | Year: 2015
Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents.We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals mean GM-ITE score.A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score.Appropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.
PubMed | Shizuoka Saiseikai General Hospital, Shonan International Village Clinic, Osaka Kita Homecare Clinic, Tokyo Shinjuku Medical Center and 15 more.
Type: | Journal: Palliative medicine | Year: 2016
Changes in activities of daily living in cancer patients may predict their survival. The Palliative Prognostic Index is a useful tool to evaluate cancer patients, and adding an item about activities of daily living changes might improve its predictive value.To clarify whether adding an item about activities of daily living changes improves the accuracy of Palliative Prognostic Index.Multicenter prospective cohort study.A total of 58 palliative care services in Japan.Patients aged >20years diagnosed with locally extensive or metastatic cancer (including hematological neoplasms) who had been admitted to palliative care units, were receiving care by hospital-based palliative care teams, or were receiving home-based palliative care. Palliative care physicians recorded clinical variables at the first assessment and followed up patients 6months later.A total of 2425 subjects were recruited and 2343 of these had analyzable data. The C-statistic of the original Palliative Prognostic Index was 0.801, and those of modified Palliative Prognostic Indices ranged from 0.793 to 0.805 at 3weeks. For 6-week survival predictions, the C-statistic of the original Palliative Prognostic Index was 0.802, and those of modified Palliative Prognostic Indices ranged from 0.791 to 0.799. The weighted kappa of the original Palliative Prognostic Index was 0.510, and those of modified Palliative Prognostic Indices ranged from 0.484 to 0.508.Adding items about activities of daily living changes to the Palliative Prognostic Index did not improve prognostic value in advanced cancer patients.
PubMed | Tokyo Metropolitan Tama Medical Center, Rakuwakai Otowa Hospital, Teine Keijinkai Medical Center, VA Ann Arbor Healthcare System and 2 more.
Type: Journal Article | Journal: Journal of hospital medicine | Year: 2016
Though hand hygiene is an important method of preventing healthcare-associated infection, we found suboptimal hand hygiene adherence among healthcare workers in 4 diverse Japanese hospitals (adherence rates of 11%-25%).Our goal was to assess multimodal hand hygiene intervention coupled with a contest to improve hand hygiene adherence.A total of 3 to 4 inpatient wards in 3 Japanese hospitals.Pre-post intervention study.The intervention was a multimodal hand hygiene intervention recommended by the World Health Organization that was tailored to each facility. The hospital with the highest adherence after the intervention was given $5000 US dollars and a trophy, provided by an American coinvestigator unaffiliated with any of the Japanese hospitals.We tracked hand hygiene adherence rates before patient contact for each unit and hospital and compared these to pre-intervention adherence rates.We observed 2982 postintervention provider-patient encounters in 10 units across 3 hospitals. Hand hygiene adherence rates were improved overall after the intervention (18% pre- to 33% postintervention; P<0.001), but postintervention adherence rates varied considerably: hospital A+29%, B+5%, C+8%. Hospital A won the contest with 40% adherence after the intervention.Using a novel contest coupled with a multimodal intervention successfully improved hand hygiene rates among Japanese healthcare workers. Given the overall low rates, however, further improvement is necessary.
PubMed | Tohoku Fukushi University, Northern Fukushima Medical Center, Gunma University, Japan Community Healthcare Organization and Yachiyo Rehabilitation College
Type: Journal Article | Journal: The American journal of occupational therapy : official publication of the American Occupational Therapy Association | Year: 2016
This study established motor function cutoff values for dressing independence in inpatients with stroke.Ninety-eight first-time inpatients with stroke were divided into groups on the basis of independence level in dressing, and receiver operating characteristic curves were determined for balance, motor function of affected limbs, trunk function, motor function of unaffected upper limb, and cognitive function.Area under the curve for the Berg Balance Scale (BBS) was highest for the different motor functions. In distinguishing independence group and supervision or less level group, the cutoff value for the BBS was 44 points (sensitivity = 85%, specificity = 93%). In distinguishing supervision or higher level group and dependence group, the cutoff value for the BBS was 32 points (sensitivity = 94%, specificity = 79%).Balance was strongly correlated with the level of dressing independence, and cutoff values for the BBS were indicators of the balance required to reach independent and supervision levels of dressing.
Narita M.,Okinawa Chubu Hospital |
Tokuda Y.,Japan Community Healthcare Organization |
Barnett P.,University of Nevada, Reno
QJM | Year: 2016
It poses a serious problemif physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians.
Watari T.,Tokyo Joto Hospital |
Tokuda Y.,Japan Community Healthcare Organization
BMJ Case Reports | Year: 2015
The differential diagnosis of causes of seizure is important since appropriate management depends on correct diagnosis. Making a misdiagnosis of epilepsy may lead to erroneous clinical management, and can be minimised with careful history taking and physical examination. Our educational case illustrates a patient with presumed epilepsy based on a witnessed generalised tonic-clonic seizure; he was ultimately diagnosed as upper gastrointestinal bleeding initially considered by careful attention of vital signs and rectal examination, and con firmed and treated by emergent endoscopy. Paying careful attention to the symptoms and signs in patients with seizure episodes is crucial to establishing a correct causative diagnosis for seizure. Copyright © 2015 BMJ Publishing Group. All rights reserved.
A comparison of estimated drug costs of potentially inappropriate medications between older patients receiving nurse home visit services and patients receiving pharmacist home visit services: A cross-sectional and propensity score analysis
Hamano J.,University of Tsukuba |
Ozone S.,University of Tsukuba |
Tokuda Y.,Japan Community Healthcare Organization
BMC Health Services Research | Year: 2015
Background: There have been no multicenter studies that estimated the relations of either nurse or pharmacist home visit program to drug costs of potentially inappropriate medications (PIMs). This study aimed to establish whether patients who used nurse or pharmacist home visit programs (nurse or pharmacist program) had lower drug costs of PIMs than those who did not use nurse or pharmacist programs for older patients living at home. Methods: This cross-sectional study was conducted in home care settings in Japan, involving 430 patients aged 65 or older, of whom 276 were female. All received regular home visits from five clinics between May and December 2013. After the PIMs were identified with the Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria, we estimated the drug costs based on actual pharmaceutical prices and measured against who using nurse or pharmacist programs after a propensity score weighted adjustment. Results: Patients who used nurse programs had lower drug cost of PIMs than those who did not use, but it was not significantly different (5.9 ± 13.1 vs 7.1 ± 13.9 USD per month, P = 0.199). The cost of PIMs for patients who used pharmacist programs also had no difference. (7.2 ± 14.5 vs 5.5 ± 11.5 USD per month, P = 0.06). In the patient groups who used nurse programs, patients who also used pharmacist programs had significantly higher costs of PIMs than those who used only nurse programs (5.5 ± 13.9 vs 2.5 ± 6.0 USD per month, P = 0.006). In patients group who did not use pharmacist programs, patients who only used nurse programs had significantly lower costs of PIMs than those who did not use nurse programs (3.6 ± 7.7 vs 5.8 ± 12.7 USD per month, P = 0.022). Conclusions: Patients who used nurse program have a trend towards lower drug costs of PIMs than those who used nurse and pharmacist program or pharmacist program alone. Although this study tried to adjust the potential confounders as possible as we could by using propensity score analysis, further studies are needed to confirm our results. © 2015 Hamano et al.; licensee BioMed Central.
Abe T.,University of Tsukuba |
Takahashi O.,St Lukes Life Science Institute Center for Clinical Epidemiology |
Saitoh D.,National Defense Medical College |
Tokuda Y.,Japan Community Healthcare Organization
Critical Care | Year: 2014
Introduction: Helicopter emergency medical services with a physician (HEMS) has been provided in Japan since 2001. However, HEMS and its possible effect on outcomes for severe trauma patients have still been debated as helicopter services require expensive and limited resources. Our aim was to analyze the association between the use of helicopters with a physician versus ground services and survival among adults with serious traumatic injuries.Methods: This multicenter prospective observational study involved 24,293 patients. All patients were older than 15 years of age, had sustained blunt or penetrating trauma and had an Injury Severity Score (ISS) higher than 15. All of the patient data were recorded between 2004 and 2011 in the Japan Trauma Data Bank, which includes data from 114 major emergency hospitals in Japan. The primary outcome was survival to discharge from hospitals. The intervention was either transport by helicopter with a physician or ground emergency services.Results: A total of 2,090 patients in the sample were transported by helicopter, and 22,203 were transported by ground. Overall, 546 patients (26.1%) transported by helicopter died compared to 5,765 patients (26.0%) transported by ground emergency services. Patients transported by helicopter had higher ISSs than those transported by ground. In multivariable logistic regression, helicopter transport had an odds ratio (OR) for survival to discharge of 1.277 (95% confidence interval (CI), 1.049 to 1.556) after adjusting for age, sex, mechanism of injury, type of trauma, initial vital signs (including systolic blood pressure, heart rate and respiratory rate), ISS and prehospital treatment (including intubation, airway protection maneuver and intravenous fluid). In the propensity score-matched cohort, helicopter transport was associated with improved odds of survival compared to ground transport (OR, 1.446; 95% CI, 1.220 to 1.714). In conditional logistic regression, after adjusting for prehospital treatment (including intubation, airway protection maneuver and intravenous fluid), similar positive associations were observed (OR, 1.230; 95% CI, 1.017 to 1.488).Conclusions: Among patients with major trauma in Japan, transport by helicopter with a physician may be associated with improved survival to hospital discharge compared to ground emergency services after controlling for multiple known confounders. © 2014 Abe et al.
PubMed | University of Nevada, Reno, Japan Community Healthcare Organization and Okinawa Chubu Hospital
Type: Journal Article | Journal: QJM : monthly journal of the Association of Physicians | Year: 2016
It poses a serious problem if physicians leave a hospital without having a replacement or without permission. A huge earthquake followed by a devastating tsunami seriously damaged the Fukushima-Daiichi nuclear power plant. This disaster overwhelmed a major teaching hospital in the local area and many hospital employees, including some resident physicians, left the premises. Since the threat of severe radiation exposure poses a potentially greater lifetime risk to younger individuals, letting the young resident physicians leave the hospital was not only allowed, it was actually recommended by many attending physicians and hospital administrators. The hospital administrator was required to make the difficult decision of whether to make all efforts to provide the highest level of medical care, including keeping all of the physicians on the premises, or to evacuate the resident physicians in order to preserve their health and their potential future contributions to healthcare. Consideration and compassion needed to be provided to all people, regardless of the reason they wanted to leave. From an ethical perspective, the roles of performance under these complex circumstances should be understood and embraced by us as individuals, professionals, supervisors and society as a whole.
PubMed | Tokyo Metropolitan Tama General Medical Center, Tokyo Electron, Japan Community Healthcare Organization and University of Pittsburgh
Type: Journal Article | Journal: American journal of infection control | Year: 2016
Given the concerns surrounding the overuse of carbapenem antibiotics in Japan, we evaluated the impact of infectious disease consultation and a prospective carbapenem audit at a tertiary care center in Tokyo, Japan. Overall, carbapenem use was safely and effectively reduced after implementation of these interventions. The leadership of the infectious diseases physicians also proved critically important to implementing effective stewardship.