18-3 Early effect of carbonated water administration on liquid gastric emptying: crossover study using the 13C breath test / 日本温泉気候物理医学会雑誌

Background and Aims: The gastrointestinal motility effects by carbonated water have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial carbonated water administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test. Methods: Eight healthy volunteers (F/M; 3/5) participated in this randomized, 3-way crossover study. The subjects fasted overnight and were randomly assigned to receive 200mL of carbonated water before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C acetate) or 200mL of carbonated water before the test meal or the test meal alone. Under all conditions, breath samples were collected for 150 min following the meal. Liquid gastric emptying was estimated by the values of the following parameters: T1/2, Tlag, the gastric emptying coefficient (GEC) and the regression-estimated constants (β and κ), calculated using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 3 test conditions were compared statistically. Results: Carbonated water significantly decreased k and beta, but T1/2, Tlag and GEC remained unchanged. Conclusions: The present study revealed that carbonated water has dual effects on liquid emptying: an initial acceleration with a subsequent deceleration in asymptomatic volunteers.

18-3Early effect of carbonated water administration on liquid gastric emptying: crossover study using the ¹³C breath test / 日本温泉気候物理医学会雑誌

<b>Background and Aims: </b>The gastrointestinal motility effects by carbonated water have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial carbonated water administration might have an effect on the rate of liquid gastric emptying using the ¹³C-acetic acid breath test.<BR><b>Methods:</b> Eight healthy volunteers (F/M; 3/5) participated in this randomized, 3-way crossover study. The subjects fasted overnight and were randomly assigned to receive 200mL of carbonated water before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg ¹³C acetate) or 200mL of carbonated water before the test meal or the test meal alone. Under all conditions, breath samples were collected for 150 min following the meal. Liquid gastric emptying was estimated by the values of the following parameters: T_1/2, T_lag, the gastric emptying coefficient (GEC) and the regression-estimated constants (β and κ), calculated using the ¹³CO₂ breath excretion curve using the conventional formulae. The parameters between the 3 test conditions were compared statistically.<BR><b>Results: </b>Carbonated water significantly decreased k and beta, but T_1/2, T_lag and GEC remained unchanged.<BR><b>Conclusions: </b>The present study revealed that carbonated water has dual effects on liquid emptying: an initial acceleration with a subsequent deceleration in asymptomatic volunteers.

Comparative Study of 2 Different Questionnaires in Japanese Patients: The Quality of Life and Utility Evaluation Survey Technology Questionnaire (QUEST) Versus the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease Questionnaire (FSSG)

BACKGROUND/AIMS: The aim of this study was to examine the convenience of the quality of life and utility evaluation survey technology (QUEST) questionnaire and the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire as self-assessment diagnostic instrument. METHODS: This was a two-way crossover study conducted over 6 weeks from September 2010 to November 2010. The subjects were 60 consecutive patients admitted to the Hiratsuka city hospital with a gastrointestinal condition, regardless of the coexistence of heartburn. They were assigned to fill in both the QUEST and FSSG questionnaires in random order. We analyzed the time taken to complete the questionnaires, whether subjects asked any questions as they filled in the questionnaire, and the questionnaire scores. RESULTS: Comparison of the QUEST and the FSSG revealed significant differences in the completion time (196.5 vs. 97.5 seconds, respectively; P or = 4 was lower than < 4 (170.5 vs. 214.0 seconds, respectively; P = 0.022), and the QUEST score was significantly higher without questions than with question (3 vs. 1 points, respectively; P = 0.025). CONCLUSIONS: This study revealed that the FSSG questionnaire may be easier for Japanese subjects to complete than the QUEST questionnaire.

Early Effect of Single-dose Sitagliptin Administration on Gastric Emptying: Crossover Study Using the 13C Breath Test

BACKGROUND/AIMS: The gastrointestinal motility effects of endogenous incretin hormones enhanced by dipeptidyl peptidase-IV (DPP-IV) inhibitors have not yet been sufficiently investigated. The aim of this study was to determine whether single pre-prandial sitagliptin, the DPP-IV inhibitor, administration might have an effect on the rate of liquid gastric emptying using the 13C-acetic acid breath test. METHODS: Ten healthy male volunteers participated in this randomized, two-way crossover study. The subjects fasted for overnight and were randomly assigned to receive 50 mg sitagliptin 2 hours before ingestion of the liquid test meal (200 kcal per 200 mL, containing 100 mg 13C-acetate) or the test meal alone. Under both conditions, breath samples were collected for 150 minutes following the meal. Liquid gastric emptying was estimated by the values of the following parameters: the time required for 50% emptying of the labeled meal (T1/2), the analog to the scintigraphy lag time for 10% emptying of the labeled meal (Tlag), the gastric emptying coefficient and the regression-estimated constants (beta and kappa), calculated by using the 13CO2 breath excretion curve using the conventional formulae. The parameters between the 2 test conditions were compared statistically. RESULTS: No significant differences in the calculated parameters, including T1/2, Tlag, gastric emptying coefficient or beta and kappa, were observed between the 2 test conditions. CONCLUSIONS: The present study revealed that single-dose sitagliptin intake had no significant influence on the rate of liquid gastric emptying in asymptomatic volunteers.

Feasibility and Validity of a Computer-based Version of SEIQoL-DW Compared to Original Interview-based Versions in Healthy Medical Students / General Medicine

<b>Purpose:</b> The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) is designed to investigate an individual's perspective on their own quality of life (QOL) and has been used widely among various clinical populations, including cancer patients and those with chronic kidney disease, in addition to healthy participants. While the original SEIQoL-DW is a semi-structured interview, other formats have been developed; recently computer-based versions have yielded equivalent results comparable to paper-based versions. However, no previous study has examined differences between the computer-based version and its original interview-based design. The purpose of this study is to assess the feasibility and validity of a computer-based version of the SEIQoL-DW, compared with the original interview-based format.<br><b>Methods:</b> We conducted a non-randomized crossover study with 13 medical students from November 2008 to January 2009 at a municipal university in Yokohama, Japan. Both the computer-based and interview-based versions of SEIQoL-DW were administered to all study participants. Wilcoxon-signed rank test was used to compare differences in mean SEIQoL Index score between computer-based and interview-based results. The intra-class correlation coefficient and the Bland and Altman limits of agreement methods were used to compare formats.<br><b>Results:</b> No significant differences were found in the SEIQoL-DW Index between the computer-based and interview versions after analysis with Wilcoxon-signed rank test (p = 0.501). The intra-class correlation between formats was 0.94 (CI: 0.81–0.98). The limit of agreement analysis showed that 53.3% of the observations were within ±1–5 units of the average score, while 46.7% were within ±5–10 units. In total, 100% of observations were within ±1–10 units.<br><b>Conclusions:</b> The computer-administered version of SEIQoL-DW may be feasible and acceptable and provides a valid alternative, at least in healthy subjects, to the more cumbersome interview version. Use of the computer-based version will facilitate its application to larger patient populations in various clinical settings.

Effects of Histamine-2 Receptor Antagonists and Proton Pump Inhibitors on the Rate of Gastric Emptying: A Crossover Study Using a Continuous Real-Time 13C Breath Test (BreathID System)

BACKGROUND/AIMS: The effects of Histamine-2 receptor antagonists and proton pump inhibitors on the gastrointestinal motility have not yet been sufficiently investigated. The aim of this study was to determine the effects of intravenous bolus administration of famotidine and omeprazole on the rate of gastric emptying using the continuous 13C breath test (BreathID system, Exalenz Bioscience Ltd, Israel). METHODS: Twelve healthy male volunteers participated in this randomized, 3-way crossover study. After fasting overnight, the subjects were randomly assigned to receive 20 mg of famotidine, 20 mg of omeprazole or 20 mL of saline alone by intravenous bolus injection before a test meal (200 kcal per 200 mL, containing 100 mg of 13C-acetate). Gastric emptying was monitored for 4 hours after the ingestion of test meal by the 13C-acetic acid breath test performed using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, the T1/2, Tlag, GEC, beta and kappa, were observed among the 3 test conditions. CONCLUSIONS: The study revealed that intravenous administration of gastric acid suppressant drugs had no significant influence on the rate of gastric emptying in comparison with that of saline alone as a placebo. Our results indicating the absence of any effect of either famotidine or omeprazole on accelerating the rate of gastric emptying suggest that both medications can be administered safely to patients suffering from hemorrhagic peptic ulcers who need to be kept nil by mouth from the viewpoint of possible acceleration of gastrointestinal motility in the clinical setting.

Mosapride Accelerates the Delayed Gastric Emptying of High-Viscosity Liquids: A Crossover Study Using Continuous Real-Time 13C Breath Test (BreathID System)

BACKGROUND/AIMS: The administration of liquid nutrients to patients is often accompanied by complications such as gastroesophageal reflux. To prevent gastroesophageal reflux, high-viscosity liquid meals are used widely, however, it still remains controversial whether high-viscosity liquid meals have any effect on the rate of gastric emptying. The present study was conducted with the aim of determining whether high-viscosity liquid meals had any effect on the rate of gastric emptying and mosapride might accelerate the rate of gastric emptying of high-viscosity liquid meals. METHODS: Six healthy male volunteers underwent 3 tests at intervals of > 1 week. After fasting for > 8 hours, each subject received one of three test meals (liquid meal only, high-viscosity liquid meal [liquid meal plus pectin] only, or high-viscosity liquid meal 30 minutes after intake of mosapride). A 13C-acetic acid breath test was performed, which monitored the rate of gastric emptying for 4 hours. Using the Oridion Research Software (beta version), breath test parameters were calculated. The study parameters were examined for all the 3 test conditions and compared using the Freidman test. RESULTS: Gastric emptying was significantly delayed following intake of a high-viscosity liquid meal alone as compared with a liquid meal alone; however, intake of mosapride prior to a high-viscosity liquid meal was associated with a significantly accelerated rate of gastric emptying as compared with a high-viscosity liquid meal alone. CONCLUSIONS: This study showed that high-viscosity liquid meals delayed gastric emptying: however, mosapride recovered the delayed rate of gastric emptying by high-viscosity liquid meals.

The nursing practice program in the new intern orientation / 医学教育

1) Yokohama City University Hospital has provided a 1-day nursing practice program during the orientation period for first-year interns since 2004. Here we report on the practice performed this year.2) After taking part in the practice, interns described the communication and consultation among the medical team as well as the nurse-patient and nurse-physician relationships. In addition, they recognized the professionalism of nursing.3) To assess the clinical outcome of this practice, we would use the attitude evaluation by head nurses of wards.

What is the difference between a <I>kenshui</I>, a resident, and an intern? / 医学教育

1) The Japanese term “<I>kenshui</I>”was officially defined in2004when the new postgraduate medical education system began.<BR>2) Although“<I>kenshui</I>”is often translated into English as “<I>resident</I>, ”it is best translated as “<I>intern</I>, ”because a kenshui rotates through many different departments.<BR>3) A United States-style residency is more akin to what is called “<I>koki-kenshu</I>” in Japanese.<BR>4) The “postgraduate year”naming system is the most precise way to describe the position of a physician in postgraduate training.

Comparative Analysis of Faculty Development in Japanese Medical Schools from 2003 through 2005 / 医学教育

1) The faculty development at each medical school from 2003 through 2005 was analysed.<BR>2) The major themes in faculty development were problem based learning, tutorial, computer based testing, and clinical training.<BR>3) Faculty development is considered an effective way to enhance the contributions of faculty members to medical education.

Curriculum of Medical Schools in North America Offering Various Education Programs: A Report of the Inspection Tour Organized by Dr. Hinohara in July, 2005 / 医学教育

1) The study tour was organized by Dr. Hinohara to learn about the medical education in North America and its philosophy to support the method.<BR>2) The McMaster University, which started PBL curriculum in 1969, began COMPASS curriculum which focuses on conceptual thinking and e-learning in which tutorial groups still remain as the key to the learning process.<BR>3) The Duke University, which values the researcher promotion, began a new curriculum including at further integration of basic and clinical medicine and structural clinical training (Intersession).<BR>4) The Washington University, which constructed WWAMI Program that cooperated with the medical institutions in four states surrounding Washington, started College System to support the students and to strengthen their clinical competencies.<BR>5) Common aspects of the innovation of medical education in North America are (1) further integration of the basic and clinical medicine, (2) early exposure to the principle of clinical medicine and (3) promotion of professionalism by Clinical Preceptorship.

Effect of Workshops for Preparing Multiple-Choice Questions for Computer-Based Testing Used in the Nationwide Common Examination Before Clinical Clerkships / 医学教育

Computer-based testing (CBT) has been used in Japan since 2002 to assess medical students' basic and clinical medical knowledge, based on the model core-curriculum, before they start clinical clerkships. For effective CBT, multiplechoice questions must accurately assess the knowledge of students. Questions for CBT are submitted by all medical schools in Japan. However, only 40% of questions are chosen for CBT and used at random; the other 60% of questions are rejected because of poor quality. Toimprove the ability of medical staff to devise questions, workshops were held at 30 medical schools. The acceptance rate of questions from schools where workshops were held was significantly increased. The workshops were extremely effbctive for improving the quality of questions.

Desirable Educational Environment for the Better Clinical Clerkship / 医学教育

In order to implement, or enhance the quality of clinical clerkship, it is necessary to develop good educational environment which will be appropriate to allow medical students participate in medical team services. Important things to be considered will be, (1) Systematic management of the individual department's program by the faculty of medicine, (2) Developing educational competency within the medical care team function, and (3) Nurturing students' awareness forself-diected learning and cooperative team work, and teaching- and medical staffs' awareness of their educational responsibilities. In this paper, to develop better educational environment for clinical clerkship, we propose a desirable situation of the educational organization, dividedly describing on the roles of dean, faculties, board of education, department of medical education, clerkship director, teaching physicians, residents and medical students.

Evaluation of the Model Core Curriculum for Clinical Clerkship / 医学教育

In March 2001, Research and Development Project Committee for Medical Educational Programs proposed a model core curriculum for undergraduate medical education. In this curriculum, implementation of the clinical clerkship is strongly recommended. Two similar curriculum models were later presented by other organizations, and some differences were observed among them. We, Undergraduate Medical Education Committee, have evaluated and compared themodel core curriculum 2001 with the Japanese newer proposals as well as those of USA and UK. Here is reported our proposals for a better rewriting of the learning objectives in the model core curriculum 2001, with some emphasis on the nurture of the competence of the case presentation and decision making process.

Problems in Preparing Multiple Choice Questions for Computer-based Testing Used in the Nationwide Common Examination before Clinical Clerkships / 医学教育

In 2002, Japanese medical students began computer-based testing (CBT) to assess their basic and clinical medical knowledge, based on the model core-curriculum, before starting clinical clerkships. Of 9, 919 multiple choice questions submitted by 80 medical schools, 2, 791 were used for CBT and 7, 128 were rejected. To improve the quality of future CBT, we analyzed why questions were rejected. The most commons reasons were difficulty, length, and inappropriate choice of answers. A training course may be needed to improve the ability of medical school staff to devise questions.