Heterogeneous adhesion of cells on polymer surfaces with underlying amorphous/crystalline phases.

Fibroblastic adhesion behaviour on films of a poly[(2-methoxyethyl vinyl ether) (PMOVE)-block-(l-lactic acid) (PLLA)], in which the surface was covered with PMOVE, was studied. Fibroblasts were sufficiently sensitive to identify crystalline/non-crystalline regions existing beneath the surface PMOVE layer.

Simultaneous detection of multiple transgenes for genetically-modified mouse strains.

Recent advances in the genetic manipulation of mice have enabled us to generate transgenic and knockout mice. However, it is not easy to maintain these genetically-modified mice with the high-quality necessary to meet both scientific and legal requirements. RIKEN BRC has collected various transgenic, knockout, and conditional knockout mice. To examine the genetic modifications in these strains quickly and thoroughly, we established a simultaneous PCR test to detect multiple transgenes. We have called this, the "KO-survey". The PCR condition was optimized to detect neo, puro, pgk-neo, lacZ, and HSVtk-neo in set I, and hyg, IRES, cre, flp, and Gfp in set II. This "KO-survey" is useful for providing users with mouse strains of the highest genetic quality and accurate information on their genetic modifications.

Should we tell the truth? Why families in Japan chose to tell their loved ones they were victims of iatrogenic HIV infection.

Japanese families traditionally avoid disclosing diagnoses of terminal illnesses to patients, seeking to protect the patient from emotional pain and shock. Using awareness theory, in this study we aimed to investigate the attitudes toward disclosure among bereaved families of Japanese hemophiliacs with iatrogenic HIV/AIDS. Semistructured interviews were conducted with 34 bereaved family members. Qualitative content analysis centered around three main issues: (a) family attitudes toward physician nondisclosure of HIV diagnosis; (b) family attitudes regarding the consequences of nondisclosure; and (c) family attitudes regarding the impact of nondisclosure on patient-family relationships. Our findings suggest that families favored disclosure because they felt that knowledge of the iatrogenic HIV infection would benefit the patient.

How families in Japan view the disclosure of terminal illness: a study of iatrogenic HIV infection.

Physicians in Japan typically do not disclose diagnoses of terminal illnesses to patients, in deference to the wishes of family members. Nonetheless, some evidence indicates that relatives of patients with iatrogenic HIV infection would prefer patient disclosure. We collected survey data from 314 family members in 225 households of hemophiliac patients who died from illnesses related to iatrogenic HIV infection in order to examine current attitudes toward patient disclosure in Japan. Family members reported that the diagnosis of iatrogenic HIV infection was disclosed to the patient by the primary physician in 32.8% of cases, by the family in 8.3% of cases, and not disclosed in 26.4% of cases. The majority of families indicated that the timing of the physician's disclosure occurred too late. Multivariate analysis indicated that families wished that patients had been informed of the diagnosis, despite the stigma associated with HIV in Japan. Furthermore, many families blamed the physician for the infection and fatality in those cases in which the physician did not convey feelings of regret. These results have important clinical ramifications to the practice of disclosing terminal diagnoses in Japan.

Working condition factors associated with time pressure of nurses in Japanese hospitals.

In Japan, the most common reason for medical errors is a lack of cross-checking. To prevent errors, efforts to strengthen cross-checking behaviors are being adopted. However, time pressures also lead to errors, and increasing cross-checking activities leads to an increased workload and even greater time pressures. The purpose of this study was to identify working conditions that lead to time pressure for nurses, and to find ways to reduce time pressure and prevent subsequent errors. Self-reporting questionnaires were distributed over 10 days to 416 nurses working in 17 wards at two hospitals; 357 nurses (85.8%) responded anonymously, providing data on 2,150 person-days. In multivariate analyses, medical support services and the number of nurse calls answered were associated with subjective assessments of time pressures and nursing service delays due to busyness. Moreover, working the "evening-day shift" (when a nurse works a day shift after working the evening shift with no days off in between) led to a high level of fatigue before work and was associated with nursing service delays due to busyness. Reducing time pressures and preventing errors requires an adequate number of nurses, shift plans that consider rest periods and order of rotation, increased task discretion for nurses, and the prevention of chronic fatigue.

The intent and practice of condom use among HIV-positive men who have sex with men in Japan.

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed.

Effects of working conditions on intravenous medication errors in a Japanese hospital.

AIM: The aim of this study was to explore quantitatively which working conditions influence the occurrence of medical near-miss errors related to intravenous medication at a hospital in Japan. BACKGROUND: Although working conditions such as stress, fatigue and inexperience have been reported to contribute to medical errors, countermeasures to these conditions have been delayed, and working conditions have deteriorated in many Japanese medical sites. METHODS: A self-reporting questionnaire analysing working conditions that can lead to near-miss errors relating to intravenous medication was sent to 90 nurses working in four wards of one Japanese hospital in 2001. Eighty-eight subjects responded (response rate: 97.8%). Among 534 person-days in which 88 nurses attended works, 525 person-days of data were used for the analyses. RESULTS: Among 525 person-days, the number of near-miss errors was 94 (17.9%). There was no significant difference in the occurrence of near-miss errors among the three shifts (day shift, 19.2%; evening shift, 19.2%; night shift, 12.5%). During the day shift, errors were reported at a significantly higher frequency when the nursing services were delayed longer due to workload. During the evening shift, errors were reported when the nursing services were delayed longer due to workload and when years of experience at the current ward were shorter. In addition, nurses whose perceived level of fatigue before work was lower during the day shift, and nurses whose years of experience as a nurse were longer and who had longer sleep duration during the evening shift experienced near-miss errors with a significantly higher frequency than other nurses. These latter factors could be important conditions that encourage the detection of errors before they occur. CONCLUSIONS: Workload and lack of experience at the current ward are two conditions that can lead to errors. Furthermore, lack of fatigue and long experience as a nurse may help encourage the detection of errors before they occur. It is important to improve working conditions so that health care workers can detect errors before patients are harmed and decrease the number of errors that occur.

Physician-patient communication and patient satisfaction in Japanese cancer consultations.

Over the past few decades, physician-patient communication has been intensively studied in western countries, because of its importance for the physician-patient relationship and patient health outcomes. Although various concepts and models of this relationship have recently been introduced in Japan, there are few studies on Japanese physician-patient interaction. The purpose of this study is to describe characteristics of physician-patient communication in a Japanese cancer consultation, and to examine the relation of this interaction with patient satisfaction. One hundred and forty cancer outpatients and twelve physicians were included. The Roter Interaction Analysis System (RIAS), one of the most frequently used systems for analyzing physician-patient interaction, was applied, physicians made more utterances directing the interaction than patients did, and their discussion was largely focused on biomedical topics. It can be concluded that the structure of the physician-patient interaction in our study was basically similar to those in previous western studies, although some differences were also found. The relation between physician-patient communication and patient satisfaction was generally consistent with previous studies. Patients were more satisfied with consultations in which the physician used more open-ended questions. On the other hand, physician direction and encouragement was negatively associated with patient satisfaction. Also, patients who asked more questions were less satisfied with the consultation.

The interaction between physician and patient communication behaviors in Japanese cancer consultations and the influence of personal and consultation characteristics.

The communications of physician and patient vary with the characteristics of patient and consultation, as well as the communications of the counterpart. The purpose of this study is to explore the interaction between physician and patient communications in Japanese cancer consultation in view of the influence of patient and consultation characteristics. One hundred and forty cancer outpatients and 12 physicians were included in this study. The Roter Interaction Analysis System (RIAS) was used to analyze the physician-patient interaction. Patient information giving was positively related to physician facilitation, while patient question asking and emotional expression were associated with the warm and empathetic attitude of the physician. On the other hand, the encouraging statements of the physician were greater in shorter consultations, which implies physicians might have interrupted patients with encouragement before thoroughly listening to the patients concern. Further investigation is needed to confirm the causal relationships of these interactions.