The cancer risks of medical radiation exposure associated mainly with CT scans / 日本プライマリ・ケア連合学会誌

Japan has experienced serious nuclear disaster being a country hit by atomic bombs and as well as the occurrence of recent nuclear plant accidents. On the other hand, the Japanese population is exposed to higher dose of medical radiation compared to other developed countries, which is due to increasing number of diagnostic computed tomography (CT) examinations. The correlation between low-dose radiation exposure and cancer risks has been discussed nationwide since Fukushima nuclear plant accident has occurred, whereas cancer risks due to low-dose ionizing radiation from CT scans have been evident in recent large cohort studies. Though CT scan is a valuable diagnostic tool in medical practice because of its high resolution image with speed of scanning, it is crucial to evaluate whether the use of CT is appropriate weighing the benefits and possible risks. Hospitalist is required to have core competency to improve quality of medical care of the hospital and to coordinate with other departments or co-medical workers. In this regard, we discuss how hospitalist could play a role to justify the use of CT and minimize unnecessary radiological exposure, cooperating with radiologists or radiological technologists.

The impact of hypnotic use on health problems in the community-dwelling elderly / 日本プライマリ・ケア連合学会誌

It has been reported that the prevalence of sleep disturbances increases with advancing age. Elderly patients, while being the main candidates for hypnotic therapy, are also pharmacologically susceptible to potential adverse effects. In today's busy practices, however, hypnotics tend to be readily initiated without adequate communication of their risks and benefits. We therefore investigated the relationship between hypnotic use, predominantly benzodiazepines, and health problems of community-dwelling elderly through a PubMed database search in order to obtain evidence on the risks and benefits of these drugs and contribute to their appropriate use. The results indicated that although short-term hypnotic use can improve sleep quality, the magnitude of the effect is small, and hypnotic use can increase the risk of developing dementia and fractures or injuries due to accidental falls. In addition, there is little evidence about long-term effectiveness of hypnotics. Clinicians should weigh the risks and short-term benefits of hypnotic use to appropriately manage sleep problems in the elderly.