ABSTRACT
Our previous studies have shown that spa therapy can reduce subjective symptoms and improve ventilatory function in patients with chronic obstructive pulmonary disease (COPD). The aim of this study is to measure the effects of spa therapy on walking distance during the six-minute walk test in patients with COPD. Twenty-five COPD patients hospitalized for pulmonary rehabilitation at our hospital were included in this study. Twenty-two patients were male and 3 patients were female. Two patients had stage I, 9 patients had stage II, and 14 patients had stage III COPD, according to the Global Initiative for Chronic Obstructive Lung Disease. We offered complex spa therapy (swimming training in a hot spring pool, inhalation of iodine salt solution, and fango therapy) in all patients for 4 weeks. Ventilatory function, six-minute walk distance, oxygen saturation and Borg scale were measured. Vital capacity (VC) was significantly improved by spa therapy at 4 weeks (p<0.05). The values of forced vital capacity (FVC), forced expiratory volume in one second (FEV<sub>1.0</sub>), forced expiratory flow after 75% of expired FVC (FEF<sub>75</sub>), forced expiratory flow after 50% of expired FVC (FEF<sub>50</sub>), forced expiratory flow after 25% of expired FVC (FEF<sub>25</sub>), mean expiratory flow during the middle half of the FVC (FEF<sub>25-75</sub>), residual volume (RV), functional residual capacity (FRC), peak expiratory flow (PEF) and diffusing capacity for carbon monoxide (DLco) showed a tendency to increase, however the increase in the 10 parameters was not significant. The values of six-minute walk distance before and after spa therapy were 288±106m and 323±114m, respectively (p<0.05). There was a significant decrease in values of maximum Borg Scale values (p<0.05). The values of minimum oxygen saturation and the values of oxygen saturation at rest slightly increased, but not significantly. The change of six-minute walk distance correlated with change of VC (r=0.545; p<0.05), with change of FVC (r=0.628; p<0.05), with change of FEV<sub>1.0</sub> (r=0.559; p<0.05), with change of FEF<sub>50</sub> (r=0.480; p<0.05), with change of minimum oxygen saturation (SpO<sub>2</sub>) (r=0.554; p<0.05) and with change of SpO<sub>2</sub> at rest (r=0.445; p<0.05). We found that spa therapy induced improvements in ventilatory dysfunction and six-minute walk distance in patients with COPD. The results from this study reveal that spa therapy may improve disease control and exercise tolerance in patients with COPD.
ABSTRACT
The aim of this study is to clarify the definition and recognition on continuing medical education for administrators (or leaders for residents) of 80 university hospitals and 266 clinical training hospitals as designated by the Ministry of Health and Welfare, using the questionaire consited of 5 main questions, as following:<BR>1) On the curriculum (program) of continuing medical education in their hospitals.<BR>2) On the continuing medical education system of Japan Medical Association.<BR>3) On the continuing medical education activity of the specified academic societies.<BR>4) On guide of continuing medical education for the residents.<BR>5) On definition of continuing medical education.<BR>Answers to a questionaire were returned from 227 institutions (65.6%)<BR>Analyzing the results, present situation of program curricula for continuing medical education in hospitals, participation to continuing medical education system of Japan Medical Association and Academic Societies, and consideration on continuing medical education as a hospital leader were comprehensible.
ABSTRACT
Continuing medical education for the general practitioners has been activery performed. The former committee for continuing medical education of the Japan Society for Medical Education reported the objectives of continuing medical education for general practitioners. The present committee proposed learning strategies for continuing medical education for general practitioners in accordance with specific behavioral objectives of the curriculum.<BR>It was postulated that appropriate learning strategies are necessary for physicians to provide holistic medical care in their communities, in addition to improving their medical knowledge and skills.<BR>Learning strategies in the curriculum were also coordinated with the continuing medical education system of the Japan Medical Association.