CAD/CAM splint based on soft tissue 3D simulation for treatment of facial asymmetry / 대한악안면성형재건외과학회지

BACKGROUND: Most cases of facial asymmetry involve yaw deformity, and determination of the yaw correction level is very difficult. METHODS: We use three-dimensional soft tissue simulation to determine the yaw correction level. This three-dimensional simulation is based on the addition of cephalometric prediction to gradual yaw correction. Optimal yaw correction is determined visually, and an intermediate splint is fabricated with computer-aided design and computer-aided manufacturing. Application of positioning devices and the performance of horseshoe osteotomy are advisable. RESULTS: With this procedure, accurate repositioning of jaws was confirmed and patients obtained fairly good facial contour. CONCLUSIONS: This procedure is a promising method for a widespread, predictable treatment of facial asymmetry.

Effects of Geometrical Uncertainties on Whole Breast Radiotherapy: A Comparison of Four Different Techniques / 한국유방암학회지

PURPOSE: The purpose of this study was to quantify the target coverage, homogeneity, and robustness of the dose distributions against geometrical uncertainties associated with four whole breast radiotherapy techniques. METHODS: The study was based on the planning-computed tomography-datasets of 20 patients who underwent whole breast radiotherapy. A total of four treatment plans (wedge, field-in-field [FIF], hybrid intensity-modulated radiotherapy [IMRT], and full IMRT) were created for each patient. The hybrid IMRT plans comprised two opposed tangential open beams plus two IMRT beams. Setup errors were simulated by moving the beam isocenters by 5 mm in the anterior or posterior direction. RESULTS: With the original plan, the wedge technique yielded a high volume receiving > or =107% of the prescription dose (V107; 7.5%+/-4.2%), whereas the other three techniques yielded excellent target coverage and homogeneity. A 5 mm anterior displacement caused a large and significant increase in the V107 (+5.2%+/-4.1%, p<0.01) with the FIF plan, but not with the hybrid IMRT (+0.4%+/-1.2%, p=0.11) or full IMRT (+0.7%+/-1.8%, p=0.10) plan. A 5-mm posterior displacement caused a large decrease in the V95 with the hybrid IMRT (-2.5%+/-3.7%, p<0.01) and full IMRT (-4.3%+/-5.1%, p<0.01) plans, but not with the FIF plan (+0.1%+/-0.7%, p=0.74). The decrease in V95 was significantly smaller with the hybrid IMRT plan than with the full IMRT plan (p<0.01). CONCLUSION: The FIF, hybrid IMRT, and full IMRT plans offered excellent target coverage and homogeneity. Hybrid IMRT provided better robustness against geometrical uncertainties than full IMRT, whereas FIF provided comparable robustness to that of hybrid IMRT.

Relationships between self-efficacy on health behavior and patient's assessment of rheumatoid arthritis conditions / 日本プライマリ・ケア連合学会誌

<b>Objective</b> : The purpose of this study was to examine the relationships between levels of self-efficacy on health behavior of outpatients with rheumatoid arthritis (RA) and patient's assessment of RA conditions.<br><b>Methods</b> : A cross-sectional study was performed using a self-administered anonymous questionnaire between October and December 2010 on 406 RA outpatients who consecutively visited 3 urban hospitals in Japan. The following variables were investigated ; (1) the scale of self-efficacy on health behavior in chronic disease patients (CD-SES), which has 2 subscales : active coping behavior with disease (14 items) and controllability for health (10 items). (2) The demographic data ; age, gender, duration of disease, treatment. (3) patient's assessment of RA conditions : painful joint count, swollen joint count, serum C reactive protein (CRP), patient estimate of global status (PGS) which was measured on a 100-mm visual analogue scale (0=best score), functional disability according to Japanese version of modified Health Assessment Questionnaire.<br><b>Results</b> : CD-SES data were obtained from 191 patients. 80<b>%</b> was female with mean age 64.4 yr. Total CD-SES scores significantly correlated with age, PGS and functional disability. The scores of active coping behavior with disease correlated with age, and the scores of controllability for health correlated with PGS. The other variables such as painful joint counts, swollen joint counts, and serum CRP showed no relationship with the scores of self-efficacy.<br><b>Conclusion</b> : Self-efficacy on health behavior of RA patients related to PGS and functional disability. The longitudinal study is necessary to ascertain whether the psychological support enhances self-efficacy, and affects clinically important outcome measures such as PGS.

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.

The report of the palliative care cooperation in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees”, who can't find the place they receive the palliative care, to “zero”

<b>Introduction</b>: We perform our trials in Tsurumi ward, Yokohama city aiming at reducing the number of “cancer refugees” to zero. <b>State</b>: There are many patients who receive cancer therapy outside their hometown. Once their treatment is finished due to progressive disease or deteriorating condition, they are told to leave the hospital and to get palliative care in their district. And they become so-called “cancer refugees”. The beds of palliative care units are limited so the ability to accept patients in case of emergencies is poor. In Tsurumi ward, here are a lot of home care clinics providing palliative care but the place patients want to be or receive palliative care when their condition deteriorates isn't fixed. We organized the “Tsurumi Homecare Network” as the core of medical cooperation, and have worked on improving palliative care and increasing patients who die at home. Specifically, our hospital has played a central role as a special place for palliative care, we send out our original questionnaire to home care clinics to find out how they perform palliative care and introduce patients to the appropriate clinic. Patients who are in need of hospitalization are assured acceptance. On the other hand, we propose the cancer treatment hospitals to follow their patients together with us from their early stage of cancer treatment. <b>Problem</b>: To maintain a good relationship for regional palliative care, improving the management for outpatients, strict and timely backup system, advanced quality of homecare-supporting staff for palliative care and cooperation between home care clinic doctors are necessary.

Characteristics of second-year residents intending to become a primary care physicians / 日本プライマリ・ケア連合学会誌

<b>Purpose</b> : To examine the characteristics of second-year residents intending to become primary care physicians.<br><b>Methods</b> : Using a self-administered questionnaire, we surveyed 7344 second-year residents in March, 2006. Of the 4167 responders (response rate 56.7%), the 3838 who answered that they intended to make a career choice of being clinical practitioners were taken as subjects for analysis. The odds ratios (OR) for the intention of being a primary care physician was calculated, together with the 95% confidence interval (95% CI), using logistic regression models (primary care physicians intended=1 vs. specialist intended=0) <br><b>Results</b> : In total, 56% of the residents affirmed an interest in becoming primary care physicians. Multiple stepwise logistic models showed that residents intending to become primary care physicians planned to open their own clinics in the future (OR 1.44, 95% CI : 1.20-1.73), did not wish to obtain doctor of medical science (DMSc) degrees (OR 1.29, 95% CI : 1.07-1.55), and were more likely to choose internal medicine (OR 1.44, 95% CI : 1.07-1.94).<br><b>Conclusion</b> : This study demonstrated that second-year residents who aimed to be primary care physicians were associated with more interest in opening private clinics for their future practice, preferably in the field of internal medicine, and with less interest in earning DMSc degrees.

Positive Association Between Sleeping Prone and Good Quality Sleep / General Medicine

<b>OBJECTIVE</b> : This study was conducted in a Japanese population to better understand the association between insomnia and sleeping prone.<br><b>METHODS</b> : A cross sectional questionnaire study was conducted with outpatients of St. Luke's International Hospital in August, 2007. Information on sleep position habits, symptoms, quality of life, and sleep quality was collected. The Athens Insomnia Scale (AIS) was used to measure sleep quality. Participants with an AIS score of 4 or higher were categorized as sub-threshold insomnia and as the insomnia group.<br><b>RESULTS</b> : Of the 784 subjects who returned completed questionnaires (response rate=65%) 30.4% were men. About 13% of the respondents slept in the prone position at least three times a week. Based on multivariate adjusted logistic regression analysis, there was a significant association between sleeping prone and having no problem with insomnia (odds ratio, 0.61 ; 95% CI, 0.38-0.99).<br><b>CONCLUSION</b> : These data suggest that sleeping in the prone position is associated with good quality sleep.

Medical Professionalism's themes from the viewpoint of general population: A qualitative study / 医学教育

Medical professionalism, which is of great interest in most countries, underpins the relationship between patients and doctors. The concepts of medical professionalism should be understandable not only by physicians but also by patients. However, there are few studies that evaluate the concept of medical professionalism from patients' perspective.a) We conducted two focus group interviews with 12 people who were not health care professionals. One interview was done with people who were living in Tokyo and one with people living in Osaka. Each interview was one hour long. During the interviews, we explored themes related to medical professionalism from patients' perspectives.b) We qualitatively analyzed response data from audio records of the interview and inductively extracted categories pertaining to medical professionalism. We compared our findings with the domains of the American Board of Internal Medicine's Charter on Professionalism (CP).c) We found 5 themes; 1) Primacy of patient welfare 2) Fairness 3) Social responsibility 4) Maintaining appropriate relations with industry 5) Maintaining appropriate relations with patients.d) Although our themes are almost equivalent to the principles cited in CP, there are some differences, such as the importance of maintaining appropriate relations with patients.e) Given the current findings, medical educators and trainers should continue to develop the Japanese concepts of medical professionalism in a manner that takes into consideration patients' perspectives.

Sociodemographic Characteristics for Use of Complementary and Alternative Medicine in Japan / General Medicine

BACKGROUND: Use of complementary and alternative medicine (CAM) has become popular in Japan.<BR>OBJECTIVE: To investigate associations of symptom-related CAM use with sociodemographic factors in Japan.<BR>DESIGN AND SETTING: A prospective cohort study of a nationally representative sample of households in Japan.<BR>PARTICIPANTS: Community-dwelling adults who developed at least one symptom during a 31-day period.<BR>MAIN OUTCOME MEASURES: Self-reported, symptom-related use of CAM, either physical CAM or oral CAM.<BR>RESULTS: Of 2, 453 adults, 2, 103 participants (86%) developed at least one symptom. Of these symptomatic adults, 156 (7.4% ; 95% CI: 6.3-8.5%) used physical CAM therapy. The likelihood of using physical CAM was not significantly influenced by annual household income, employment, or education. Participants living in large cities had an increased likelihood of using physical CAM with an odds ratio (OR) of 2.6 (95% CI: 1.2-5.8), compared to those living in rural areas. Oral CAM therapy was used by 480 participants (22.8%; 95% CI: 21.0-24.6%) among the symptomatic adults. An age of 60 years old and older (OR 2.0; 95% CI: 1.2-3.3) and female gender (OR 1.8; 95% CI: 1.3-2.6) were significantly associated with an increased use of oral CAM. The unemployed participants had a lower likelihood of using oral CAM, with an OR of 0.6 (95% CI: 0.4-0.9), compared to the employed.<BR>CONCLUSIONS: Oral CAM use is common among Japanese patients and is associated with older age, female gender, and employed status, while physical CAM use is less common and is associated with living in a large city.

Autoimmune Hemolytic Anemia Associated with Primary Biliary Cirrhosis / General Medicine

<b>ABSTRACT</b> : Both primary biliary cirrhosis (PBC) and autoimmune hemolytic anemia (AIHA) are uncommon diseases. Immunological dysregulation is suggested as a causative factor for both diseases. We report a 77-year-old woman who suffered from warm type AIHA complicated by PBC. Her direct antiglobulin test was positive for IgG, and negative for C3. Both anti-mitochondrial antibody and its M2 component were detected. Both alkaline phosphatase (Alp) and IgM were elevated in the serum. She was initially treated with steroids for 8 months. Her steroids were discontinued when she underwent a laparoscopic splenectomy. Ursodeoxycholic acid was discontinued due to an allergic skin reaction. Her Alp improved with bezafibrate.

Influence of Residents' Workload, Mental State and Job Satisfaction on Procedural Error: a prospective daily questionnaire-based study / General Medicine

<b>BACKGROUND</b> : Previous studies have suggested positive association between residents' workload and medical errors. However, few studies have investigated the possible associations between procedural errors, workload, and the individual characteristics of residents, including personality, mental state and job satisfaction.<br><b>OBJECTIVE</b> : To explore possible associations of workload and individual characteristics of residents with their procedural error rates.<br><b>DESIGN</b> : Prospective observational study based on a daily questionnaire.<br><b>PARTICIPANTS</b> : Residents of postgraduate year 1 and 2.<br><b>MEASUREMENTS</b> : Residents' workload (on-calls, work hours, sleep and napping hours), residents' physical and mental health state, personality inventory, and procedural error rate (defined as procedural error counts divided by overall procedural attempts).<br><b>RESULTS</b> : On average, the residents (N=49) were responsible for 9.8 inpatients per day (range, 1.9-23.1), worked for 16.0 hours per day (range, 12.6-19.8), slept for 4.4 hours per day (range, 2.8-5.7), napped for 0.2 hours per day (range, 0-0.7), and experienced 1 overnight work shift every 7.2 days. The procedural error rate was 2.2 per 10 procedures (range, 0.4-5.0). Using a multivariable adjusted regression model, significant factors associated with lower error rates included : longer napping ; reflective personality ; better mental state ; higher job satisfaction ; and, less on-call frequency.<br><b>CONCLUSIONS</b> : Procedural error of residents is positively associated with higher on-call frequency and inversely associated with napping, reflective personality, better mental state, and higher job satisfaction. For reducing procedural error among residents, improvement of modifiable factors, such as workload and mental health, is needed.

Medications Prescribed at Discharge for Patients with Acute Myocardial Infarction : Evidence-to-Practice Gap in Janan / General Medicine

BACKGROUND: The existence of a gap between research evidence and clinical practice has been described recently. Several drugs are effective in preventing secondary events after acute myocardial infarction (AMI), but it is not certain whether this evidence is employed in daily practice. We investigated the drugs currently employed for patients with a history of AMI in Japan.<BR>METHODS: Medical records of patients who developed AMI during the calendar year of 1999 were retrospectively identified at three teaching hospitals in Japan. We collected data on drugs prescribed at three time points (upon admission for AMI, at the time of discharge, and one year after discharge) for each patient.<BR>RESULTS: Data were available for 149 patients with AM!. Drugs prescribed at the time of discharge were aspirin (77.5%), nitrates (68.3%), and angiotensin converting enzyme inhibitors (52.8%) . β-blockers were prescribed for only 12.0% of patients. The drugs used one year after discharge were to a large extent similar to those at the time of discharge. There were no significant correlations between the use of these drugs and comorbidity.<BR>CONCLUSION: Despite established evidence that β-blockers offer benefits to patients with a history of AMI, they have not been prescribed frequently, for reasons that remain unclear. To improve the quality of clinical care, further systematic effort is needed to bridge this evidence to practice gap.

Evaluation of Simulation Training During an Orientation Program for New Residents / 医学教育

In 2006 26 first-year residents at St.Luke's International Hospital underwent training with a highly sophisticated simulator to learn how to treat patients with cardiopulmonary arrest or anaphylactic shock.We evaluated the effects of simulation training for first-year residents.<BR>1) After training, we analyzed the residents' performance in the 2 scenarios and the residents' satisfaction with simulation training.<BR>2) According to the resident's performance dataduring simulation training, first-year residents have sufficient skill to treat patients in cardiopulmonary arrest but not patients with anaphylactic shock.<BR>3) Twenty-five of the 26 residents (96.2%) were highly satisfied with simulation training.