ABSTRACT
We conduct an outpatient escort program as a part of our early exposure curriculum for first-year medical students. Each student escorts one patient at the University of Tsukuba Hospital throughout his or her first visit. We evaluated this program from the points of view of both students and patients.<BR>1) A questionnaire was distributed to all participating patients and students in 2006.<BR>2) In their questionnaires, many students commented on the long waiting time, the structural problems of the hospital, and the attitudes of physicians.<BR>3) Results of the questionnaire showed that both students and patients rated this program highly.<BR>4) No significant differences were noted between the comments of the students and those of the patients. The patients tended to rate this program more highly than did the students. One patient, however, commented that being constantly accompanied by a stranger was somewhat stressful.<BR>5) We conclude that this program can be efficiently carried out without being too much of a burden to patients and is a valuable part of an early exposure program for first-year medical students.
ABSTRACT
Students in their 5th and 6th year of University of Tsukuba, School of Medicine, enter into a clinical clerkship. They record medical charts and flow sheets and they present at clinical rounds.<BR>1) From 2000 to 2005, a questionnaire survey was conducted to evaluate the clinical clerkship in the rheumatology division. We also evaluated the influence of the introduction of infliximab therapy (October 2003) on the students' experience.<BR>2) Evaluation of the clinical clerkship by the students was improved by attending the infliximab ward. Students felt more involved in the treatment of the patients by preparing drip infusion sets, disssolving infliximab, assisting with the drawing of blood and drip infusions, checking of the vital signs every 30 minutes, and recording charts.<BR>3) Students realized the improvement of rheumatoid arthritis with therapy and the changes in the patients' emotional status after the introduction of infliximab.
ABSTRACT
Acupuncture analgesia were successfuly used in dental extraction in some patients who were sensitive to local anesthetics. In this study this technique was applied to daily conservative dental treatment. Acupuncture analgesia can be established by transcutaneous electric acupuncture-like stimuration (TENS) in stead of inserting needles. The TENS were applied in Hoku point and Large Intestine # 10 with 3Hz at the ipsilateral side of the dental treatment.<br>Apparatus used were Tokki and Neuro-pulse acupuncture stimulator. Wave forms of both apparatus are spike wave with pulse width of 0.1msec. Plate electrodes were conductive rubber size of 3×4cm and were fixed at Hoku point and Large Intestine # 10 with adhesive tape.<br>Stimuration was continued from 20 to 30min with the strength of producing mild twitch while patients were sitting in the waiting room. 230 patients of dental conservative treatment were given TENS before cavity preparation, gingival plastic, tooth extraction, pulpectomy and others. Treatment was started under TENS alone, and when patient bigan to complain the intolerable pain, then the subperiosteal infiltration of local anesthetic was performed.<br>(1) Cavity preparation: 78 (85%) out of 92 were performed only with TENS. In 14 (15%) patients local infiltration were added.<br>(2) Gingival plastic: 29 Patients were given only TENS. Effect of TENS were excellent for the incision of gingiva, and there were no patients who added local infiltration.<br>(3) Pulpectomy: 60 Patients had pulpectomy. Only 12 (33%) out of 36 of alive pulp were done under TENS alone. As post arsenic treatment, however, in 23 patients out of 24, removal of already dead pulp was performed under TENS with good result.<br>(4) Dental extraction: In only 5 patients (23%) out of 22 of molar teeth extraction, extraction was performed under TENS. Non molar teeth extraction had poor results, too.<br>(5) Scaling caliculi: Scaling of the dental caliculi were done under TENS with excellent results. In conclusion, TENS is a simple and easy maneuver for every dentist to alleviate pains in the conservative dental treatments.
ABSTRACT
One of the characteristics of the diagnostic method in Oriental medicine is a pulse diagnosis. In this technique, the examiner places his index, middle and ring fingers on the wrist of the patient's hand above the radial artery and determines the fullness or emptiness of the six Meridians on each hand. In order to make this subjective method more objective, three pressure transducer sensors were placed over the radial artery and its method was previously described.<br>In this study, we used this objective pulse diagnosis and selected the proper Meridian points according to 5 element theory and improper points without considering it. Then we investigated the changes of the pain threshold by the thermo-dolorimetric method before and after the acupuncture stimulation.<br>An allergic patient who developed athmatic attack by many drugs was going to have nasal polypectomy. Acupuncture points were selected by this pulse diagnosis. 9 healthy volunteers were examined whether five element or non-five element points would elevate pain threshold.<br>Results<br>(1) The elevation of pain threshold by thermo-dolorimetric method before and after the acupuncture stimulation were observed only when the proper Meridian points were stimulated.<br>(2) Nasal polypectomy was performed under acupuncture analgesia without pain following the selection of 5 element points by this objective pulse diagnosis.
ABSTRACT
Introduction<br>We attempted to get an objective index of pain, giving electro-nocistimulus to the tooth and making a comparison between the stimulus rate and subjective pain. We examined variations of the response to stimulus under this low-frequency electric treatment.<br>Method<br>Treated were single healthy upper incisors of 14 medical doctors. Fixing a silver electrode of 4mm<sup>2</sup> on each tooth and an indifferent electrode on the buccal surface of the same side, stimulation was applied.<br>Effect<br>Three categories of pain, i. e. pre-pain, tolerable pain and intolerable pain were established for the purpose of this study. We made use of these categories as an objective index of pain. It was also evident that, under low frequency electric treatment to acupoints of acupuncture anesthesia, there were variations in intolerable pain. We examined variations of this pain.<br>Conclusion<br>It was concluded that there were two types of objects, i. e. the effective and the ineffective.<br>Intolerable level was affected by the low frequency electric treatment and pain was alleviated.
ABSTRACT
One of the idiosyncracies of Oriental medicine is pulse diagnosis, the detailed stipulation of the pulse of the radial artery from which fullness or emptiness as described in JUNIKEIRAKU one manifestation of the general physical and pathological condition of the body is determined and the treatment points along the meridians, that is the appropriate acupoints decided. In this diagnostic technique the examiner places his index, middle and ring fingers on the wrist of the patient's hand above the radial pulse and by applying weak or strong pressure compares the largeness or smallness of the pulse under each finger tip and so doing determines the fullness or emptiness of the six meridians on each side or the 12 meridians on both sides.<br>In order to make this subjective method of fingertip touch diagnosis objective we used a fingertip size transducer and developed a way of measuring and recording pressure fluctuation changes resulting from the various absolute pressures exerted by the fingertips of the examiner.<br>Method:<br>The pressure transducer used was a semi-conductor curve gauge, 8mm. in diameter capable of indicating up to 500g/cm<sup>2</sup> of direct loaded pressure. The input from this one pressure inducer was amplified through different amplifiers, the absolute pressure from DC conversion in one amp, and the pressure variation component from AC conversion in another amp. It was assumed that the pressure load in pulse diagnosis was 100g/cm<sup>2</sup> for floating pulse, 200g/cm<sup>2</sup> for sunken pulse and in the pressure variation component deficiency was below 5g/cm<sup>2</sup> and excess 15g/cm<sup>2</sup>, and evaluated accordingly.<br>Subjects:<br>Pre-surgery patients and pain complaint outpatients were used as subjects. Measurements was recorded.<br>Results:<br>1. In most of the cases pulse diagnosis at the 6 areas above the radial artery revealed that centered on the styloid process at areas approximately 1cm. apart different pressure variations were observed.<br>2. Measurement of the pulse of a pre-surgery stomach cancer patient revealed Stomach and Heart Constructor Excess when the patient was in a reclining position however this reading changed with changes in posture. When the patient assumed a sitting position the pulse showed Stomach Excess however the pressure variation of the Heart Cosntructor decreases.<br>3. The pressure variation components vary with acupuncture stimulation.<br>4. In our experience we observed cases in which excess or deficiency of the various meridians varied due to acupuncture stimulation. These variations obeyed the laws of “creation and harming” of the 5 Elements Theory.
ABSTRACT
The pain eliminating effects of electroacupuncture have long been known however the analgesic mechanism involved has yet to be clarified. Recently with the discovery of endogenous analgesic peptids called endorphins much attention has been called to the relationship of these endorphins and the acupuncture analgesic effect. We examined to determine how electroacupuncture influences lumbar CSF endorphins and the so-called pain transmitting substance, Substance P.<br>In order to establish continuous lumbar anesthesia using tetracaine for 8 patients with gynecological lower abdominal diseases, a Tuohy needle was inserted from the lumbar area and a catheter inserted into the subarachnoidal space. In each case at the time of the insertion of the catheter 5ml. CSF was tapped. As pre-medication 0.01mg/kg. atropine sulfate, 2mg/kg secobarbiturate were administered. To maintain the analgesic effect hyperbaric or hypobaric tetracaine was administered according to individaul needs. For hypotension during the operations a plasma expander and when necessary ephedrine were administered by intramuscular or intravenous injection.<br>Immediately following the start of surgery acupuncture needles were inserted at right and left LI-4 and electrical stimulation at 3c/s, 1.0mA was administered for 50-120 minutes using the acupuncture therapy apparatus “TOKKI”. when the operation was finished, after 5ml. of CSF was again tapped through the catheter, the catheter was withdrawn as far as the subdural space and 20-40ml. physiological saline injected to combat the headache due to spinal fluid leakage. The test substance was immediately transferred to a siliconized test tube and cooled to a temperature of-80°C.<br>The RIA methods were used for the measurement of both endorphins and substance P. The crossover reaction between the β-endorphin and the βLPH was 50%. (Using the β-endorphin measuring kit manufactured by NEN).<br>The results in 7 of 8 examples showed a significant increase in CSF endorphins after electroacupuncture. It also became clear that there was a tendency for substance P levels to decrease due to electroacupuncture.