ABSTRACT
<b>Background: </b>Group practices with multiple physicians are preferred for promoting home medical care, but the explanations to patients and families given by the visiting doctors may differ. That could sometimes lead to confusion in patients and families.<br><b>Methods: </b>We conducted a cross-sectional mail survey of families of Japanese patients who had previously received home medical care. Multivariable adjusted logistic regression for families’ sense of discrepancy between the explanations by doctors in a group practice was performed using eleven explanatory variables including: (1) number of doctors; (2) interval between the doctors’ visits; (3) duration of the doctor’s stay; (4) doctors’ frequent use of technical terminology; (5) doctors’ interruption of family’s talking, etc.<br><b>Results: </b>Among 271 families who were mailed surveys, 227 responded (83.8%). The final sample for the analyses was 139. Responses were divided into two groups: families who had experienced a sense of discrepancy about explanations by different doctors (“Experienced”, 30 families, 21.6%) and those who had not (“Non-experienced”, 109 families, 78.4%). Families’ sense of discrepancy between the explanations by doctors in group practice was significantly associated with a longer time interval between doctors’ visits (OR: 1.103, 95% CI: 1.008–1.208, p = 0.03) and doctors interrupting families while they were talking (OR: 2.559, 95% CI: 1.166–5.615, p = 0.02).<br><b>Conclusions: </b>Visiting doctors need to understand that families may have a sense of discrepancy about explanations given by different doctors. This sense of discrepancy was associated with less frequent doctors’ visits and doctors’ interrupting families while they are talking.
ABSTRACT
We analyzed the clinical features of 21 cases with drug-induced liver injury due to Kampo medicines between the years 2000 and 2009 in our institute. The mean age in these cases was 55.2 ± 13.4 years. Five of the cases were men, and 16 were women. In 17 of the 21 cases, drug-induced liver injury had occurred within 3 months after beginning Kampo medicines. There were no subjective symptoms in 11 cases. Nine cases of both hepatocellular injury, and of mixed-type injury were seen. Causative Kampo medicines included an Ogon (<I>Scutellariae Radix</I>) component in 19 cases. A drug-induced lymphocyte stimulation test (DLST) was performed in 5 cases. The test was positive for Kampo medicines in only one of the 5 cases. Liver injury improved or normalized in 18 cases (85.7%) after discontinuing causative Kampo medicines. In another 2 cases, liver injury normalized after changing a Kampo medicine to the same prescription without Ogon. These results suggest that even if patients complain of no symptoms we must perform blood tests to check liver function within 3 months of prescribing Kampo medicines, especially those including Ogon, to facilitate early diagnosis of drug-induced liver injury.
ABSTRACT
<p><b>OBJECTIVE</b>Verotoxin-producing Escherichia coli (VTEC) strains of serotype O157 : H7 have been implicated in a wide spectrum of diseases, including blood diarrhea, hemorrhagic colitis and hemolytic uremic syndrome (HUS). To further explore the pathological role of verotoxin (VT) in HUS and other VTEC associated diseases, we investigated the effects of recombinant verotoxin 2 (rVT2) on the biological activity of neutrophils.</p><p><b>METHODS</b>The technique of flow cytometry, a fluorescent probe 2,7-bis-(2-carboxyethyl)-5-(and-6)-carboxyfluorescein acetoxymethyl ester (BCECF/AM), and the assay of reduced cytochrome c to detect superoxide production were used in this study.</p><p><b>RESULTS</b>gammaVT2 significantly inhibited spontaneous apoptosis in neutrophils. Neutrophils with prolonged survival due to gammaVT2 maintained various biological functions, such as the expression of adhesion molecules (shading CD62L and raising CD11b/CD18), adherence to human umbilical vein endothelial cells (HUVECs), and generation of superoxide (O(2)(-)).</p><p><b>CONCLUSION</b>Prolongation of the functional life-span of neutrophils by gammaVT2 may accelerate inflammatory responses at sites of inflammation. This may play a crucial role in neutrophil-mediated tissue injury in HUS and other VTEC-associated diseases.</p>