Shimizu T.,Hospitalist Division |
Tsugawa Y.,Beth Israel Deaconess Medical Center |
Tsugawa Y.,St Lukes Life Science Institute |
Tanoue Y.,University of Tokyo |
And 5 more authors.
International Journal of General Medicine | Year: 2013
It is believed that the type of educational environment in teaching hospitals may affect the performance of medical knowledge base among residents, but this has not yet been proven. Objective: We aimed to investigate the association between the hospital educational environment and the performance of the medical knowledge base among resident physicians in Japanese teaching hospitals. Methods: To assess the knowledge base of medicine, we conducted the General Medicine InTraining Examination (GM-ITE) for second-year residents in the last month of their residency. The items of the exam were developed based on the outcomes designated by the Japanese Ministry of Health, Labor, and Welfare. The educational environment was evaluated using the Postgraduate Hospital Educational Environment Measure (PHEEM) score, which was assessed by a mailed survey 2 years prior to the exam. A mixed-effects linear regression model was employed for the analysis of variables associated with a higher score. Results: Twenty-one teaching hospitals participated in the study and a total of 206 residents (67 women) participated and completed the exam. There were no residents who declined to participate in the exam. The mean GM-ITE score was 58 (standard deviation 8.4). The mixedeffects linear regression analysis showed that a higher PHEEM score was associated with a higher GM-ITE score (P = 0.02). Having a department of general medicine, and hospital location in a provincial community (versus an urban setting), were also shown to have a significant relationship with the higher score (P = 0.03, and P = 0.02, respectively). Conclusion: We found that the performance of the medical knowledge base of resident physicians was significantly associated with the educational environment of their hospitals. Improvement of the educational environment in teaching hospitals might be crucial for enhancing the performance of resident physicians in Japan. © 2013 Shimizu et al, publisher and licensee Dove Medical Press Ltd.
Katsuno M.,Kanto Rousai Hospital |
Watanabe N.,Otorhinolaryngology |
Sugio Y.,Kanto Rousai Hospital |
Tachibana S.,Kanto Rousai Hospital |
And 3 more authors.
Japanese Journal of Cancer and Chemotherapy | Year: 2010
A study of S-1 chemotherapy treatment of patients with head and neck cancer was conducted in 26 patients with residual or recurrent tumors after the initial treatment, i. e., chemoradiotherapy, radiotherapy and operation. The treatment courses consisted of oral administration of S-1 at a dose of 80 to 120 mg/day depending on the body surface area, for 14 consecutive days followed by a 7-day rest period. The response rate in all patients was 34.6% (9/26). In patients with recurrent tumors, the response rate was 11.1% (1/9). Patients with residual tumors after the initial treatment had a response rate of 47.0% (8/17). The median survival time was 490 days. Moreover, we studied the maintenance of QOL (quality of life) in 15 cases whose deaths were caused by their tumors. The maintenance duration of QOL was 162 to 1,742 days (median 330 days). The mean QOL maintenance rate, i. e., the average period of extended life with stable disease compared to the period from the eternity time of S-1 treatment until patient death, was 81.1% (36.4-98.7%). S-1 is a safe anticancer drug with fewer side-effects than other chemotherapies. S-1 did not cause any serious adverse events in the patients enrolled in this study. Therefore, S-1 appears to be useful for the treatment of patients with head and neck cancer, and it is particularly useful for improving the QOL of patients.
Nagahama K.Y.,Juntendo University |
Hayashi T.,Juntendo University |
Nagaoka T.,Juntendo University |
Kanemaru R.,Juntendo University |
And 5 more authors.
Respiratory Medicine CME | Year: 2011
Erdheim-Chester disease (ECD) is a rare non-Langerhan's cell histiocytosis of unknown origin, involving multiple organs. The patient with ECD described here is a 38-year-old man who was admitted to the hospital with dyspnea on exertion. His chest radiograph revealed a diffuse reticulonodular shadow. After the video-assisted thoracoscopic surgery was performed, he was diagnosed as having ECD. A brown eruption on his left temple, when tested by skin biopsy, proved to be ECD. No lesions other than these on the lung and skin were identified, and oral administration of predonisolone successfully treated both of them. Although recovery has followed the administration of predonisolone and chemotherapy for several patients with pulmonary ECD, this is the first report that predonisolone alone provided clinical and objective recovery from pulmonary ECD. This outcome indicates that, of all the many treatments tried for ECD, steroids may become the first-line therapy for pulmonary involvement. © 2010 Elsevier Ltd.
Adachi E.,Kanto Rousai Hospital |
Kitayama S.,Kanto Rousai Hospital |
Ogino H.,Kanto Rousai Hospital
Japanese Journal of Plastic Surgery | Year: 2014
Acquired hemophilia A (AHA) is a rare bleeding disorder caused by autoantibodies directed against coagulation factor VIII. We report 2 cases of AHA. The first case of AHA occurred in an 81-year-old woman who presented with swelling of the right lower leg. After diagnosis, the patient was administered immunomodulatory treatments, which improved her status. However, she eventually died of hemorrhagic shock resulting from gastrointestinal bleeding. The second case of AHA occurred in a 59-year-old man who presented with cellulitis of the scrotum. Desmopressin was administered prophylactically to the patient to aid hemostasis. Prolonged activated partial thromboplastin time combined with a sudden bleeding episode typically occurs in AHA patients; Therefore, immediate consultation with a specialist is vital. Furthermore, it is recommended that invasive procedures on AHA patients should be undertaken with appropriate precautions to ensure proper hemostasis.