Necessity of pharyngeal anesthesia during transoral gastrointestinal endoscopy: a randomized clinical trial

Background/Aims@#The necessity for pharyngeal anesthesia during upper gastrointestinal endoscopy is controversial. This study aimed to compare the observation ability with and without pharyngeal anesthesia under midazolam sedation. @*Methods@#This prospective, single-blinded, randomized study included 500 patients who underwent transoral upper gastrointestinal endoscopy under intravenous midazolam sedation. Patients were randomly allocated to pharyngeal anesthesia: PA+ or PA– groups (250 patients/group). The endoscopists obtained 10 images of the oropharynx and hypopharynx. The primary outcome was the non-inferiority of the PA– group in terms of the pharyngeal observation success rate. @*Results@#The pharyngeal observation success rates in the pharyngeal anesthesia with and without (PA+ and PA–) groups were 84.0% and 72.0%, respectively. The PA– group was inferior (p=0.707, non-inferiority) to the PA+ group in terms of observable parts (8.33 vs. 8.86, p=0.006), time (67.2 vs. 58.2 seconds, p=0.001), and pain (1.21±2.37 vs. 0.68±1.78, p=0.004, 0–10 point visual analog scale). Suitable quality images of the posterior wall of the oropharynx, vocal fold, and pyriform sinus were inferior in the PA– group. Subgroup analysis showed a higher sedation level (Ramsay score ≥5) with almost no differences in the pharyngeal observation success rate between the groups. @*Conclusions@#Non-pharyngeal anesthesia showed no non-inferiority in pharyngeal observation ability. Pharyngeal anesthesia may improve pharyngeal observation ability in the hypopharynx and reduce pain. However, deeper anesthesia may reduce this difference.

Disc Height Narrowing Could Not Stabilize the Mobility at the Level of Cervical Spondylolisthesis: A Retrospective Study of 83 Patients with Cervical Single-Level Spondylolisthesis

Methods@#The images of 83 patients with cervical single-level spondylolisthesis were studied. We looked at 52 slipped levels for anterior slippage and 31 for posterior slippage. The imaging parameters included slippage in the neutral, flexed, and extended positions, axial facet joint orientation, sagittal facet slope, global cervical alignment, C2–C7 angle, C2–C7 sagittal vertical axis, range of motion (ROM), and slipped disc angle ROM. @*Results@#With the narrowing of the intervertebral disc height, slippage in the flexed position of both anterior and posterior spondylolisthesis increased. However, in both anterior and posterior spondylolisthesis, disc height narrowing did not show stability. The narrowing of the intervertebral disc height was found to be a risk factor for a translation of slippage of 1.8 mm or more in flexionextension motion in anterior spondylolisthesis in multivariate regression analysis. @*Conclusions@#Narrowing the intervertebral disc height did not stabilize the translation of slippage in flexion-extension motion in cervical spondylolisthesis. Instead, narrowing of the disc height was associated with a translation of slippage of 1.8 mm or more in flexion-extension motion in cases of anterior slippage. Therefore, we discovered that degenerative cascade stabilization for cervical spondylolisthesis was difficult to achieve.

Developing a General Medicine Residency Curriculum: Lessons Learned from Family Practice Residency Training in the United States / 医学教育

Systematic residency education curricula can provide students and residents opportunities to learn a broad range of clinical skills. One curricular model for Japanese general medicine departments <I>(sogoshinryo-bu)</I> is family-practice residencies in the United States. The values of family practice include first-contact care, continuity, comprehensiveness, coordination, community health, and care of the person. The precepting system is the pillar of resident education and provides the structure for physician-teachers to guide a medical school graduate to become a competent family physician by the end of 3 years of clinical training. Family-practice centers, community-based clinics where university faculty and residents provide care, have a proven record in the United States as clinical classrooms for teaching the values and skills needed for high-quality primary care and could greatly facilitate practice-focused training in Japan.

Japanese and United States Family Medicine Resident Physicians' Attitudes about Training / General Medicine

OBJECTIVE: This is the first research known to compare residents' attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents' attitudes about their residency training.<BR>METHODS: A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues.<BR>RESULTS: The response rates were Japan, 1991: 92% (12/13) ; US, 1991: 76% (13/17) ; Japan, 1995: 89% (34/38) ; and US, 1995: 91% (60/66) . Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage.<BR>CONCLUSIONS: Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents' perspectives on training may be valuable to educators planning curriculum development.