We used a new cardiology simulator twice to train lst-year medical residents in physical examination with a specific behavioral objective shortly after they had received their medical licenses. The first training sessions were to teach residents to understand normal heart sounds and to perform physical examinations in the proper order; the second training sessions were to teach recognition of abnormal heart sounds and murmurs. After the first training sessions, all residents could perform physical examinations in the proper order with special attention to the jugular vein, differentiation of systole and diastole by palpating the carotid artery, splitting of S2, and the timing and transmission of heart murmurs. Just after the second training sessions, all residents thought that their physical examination skills and ability to recognize abnormal heart sounds and murmurs had improved. One year later, the residents were accustomed to performing physical examination in the proper order and could recognize gallop rhythms and murmurs of grade 3/6 or higher. Repeated training with specific behavioral objectives could motivate residents to understand both normal and abnormal heat sounds and murmurs.

Introduction: This study evaluated the effectiveness of co-management of the neurosurgery department by general physicians.Methods: A retrospective observational study was conducted in a tertiary hospital. Length of stay, in-hospital mortality, number of transfers to the intensive care unit (ICU) due to emergency medical problems, prescription sharing ratio with neurosurgeon, and impression reported by nurses were evaluated by comparing one year before and after the co-management of the neurosurgery department was initiated.Results: Length of stay (Median 14 days, 14 days), mortality rate (7.58%, 5.75%) and transfer rate for ICU (3.23%, 1.94%) were not significantly different between one year before and one year after, respectively. Subgroup analysis of patients over 70 years of age hospitalized for cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage showed that the number of patients transferred to the ICU due to medical problems associated with internal medicine significantly decreased (P = 0.04). A general physician was responsible for half of the prescriptions. The nurse's report was highly positive.Conclusion: Co-management of the neurosurgery department by general physicians did not have a significant effect on reducing length of stay or mortality rate; however, we found a decrease in the number of patients transferred to the ICU due to medical problems among elderly stroke patients.

Cardiac patient simulators are commonly used in Japanese educational institutions; however, most institutions have not established concrete learning objectives or strategies for mastering physical examination of the circulatory system, including cardiac auscultation. In this study, we propose clear learning objectives and strategies for simulator practice for fifth-year medical students who have passed the objective structured clinical examination, and explored their educational effectiveness.
1)The subjects were fifth-year medical students (n=94) at the University of Miyazaki. Learning objectives were the mastery of the sequential physical examination and the ability to distinguish 6 cardiac findings, including normal status. The subjects were evaluated with a checklist before and after lectures and simulator practice.
2)The mean score (maximum score=14) significantly increased from before simulator practice (2.2±0.9) to after simulator practice (11.4±1.5; p<0.001). There was no difference in scores after practice among the cardiac diseases.
3)Before practice more than 50% of subjects could use a stethoscope on only right positions and could indicate only the maximum point of a cardiac murmur; in contrast, after practice more than 90% of the subjects could sequentially describe physical findings and accurately predict cardiac diseases.
4)In a questionnaire administered after practice, 83% of the subjects answered that all physicians should acquire proficiency in cardiac auscultation regardless of their specialty.
Simulator practice with clear learning objectives may help improve clinical examination skills when both time and human resources are limited. The reevaluation of the program's continuing educational effectiveness and the establishment of an iterative learning program will be needed.

Risk factors for developing hemolytic uremic syndrome among patients with enterohemorrhagic Escherichia coli O157: H7 (EHEC) infection include age. The young, especially those under the age of five, face an increased risk, as do the elderly. In the present study, we evaluated the protective effects of Hochu-ekki-to (HET) on intraperitoneal infection with EHEC, using immunosuppressant, dexamethasone (Dex)-treated mice.
It was found that HET induced improvement of Dex-induced leukopenia. Similarly, the IgM-plaque forming cell responses to sheep red blood cell (SRBC) were restored by the administration of HET to the normal-mice level in Dex-treated mice. Consequently, HET was administered orally into the Dex-treated mice before infection with EHEC to observe the therapeutic effect. With the oral administration of 500mg/kg/head of HET into the Dex-treated mice, prolonged survival was shown: the 50% survival time in the HET-administered mice was four days, compared with one day in the non-administered controls. In addition, the number of bacteria in the liver was reduced by the administration of HET in the Dex-treated mice.
The results indicate that orally administered-HET protects against EHEC infection in Dex-treated mice, and such protective effects appear to be due to the restorative effects of HET against the Dex-induced immunosuppression.

　To encourage the broad use of simulation-based medical education and establish partnerships to promote objective structured clinical examinations after clinical clerkship among medical teachers, we hosted the first team-based clinical skills competition event for medical students in Japan, named ‘Medical Students' Simlympic Games 2014'. Thirty-six (12 teams of three) open-recruited 5th or 6th grade medical students participated in this event. Student teams performed clinical tasks at 6 stations, which actively utilized the strengths of simulators or simulated patients. Contents, composition, difficulty level, and validity were tested by trainee doctors and examined by committee members in advance. In this report, we describe our concept, executive committee formation, a variety of arrangements, the outline on the day of the event, and the results of a questionnaire targeting participants. (126 words)

As a bisphosphonate, minodronate (MIN) is one of the strongest inhibitors of bone resorption. However, there have been no reports directly comparing the antiresorptive effects of monthly MIN with those of monthly risedronate (RIS). We enrolled 30 cases of osteoporosis (OP; 16 in the MIN group [mean age: 68.2 years] and 14 in the RIS group [mean age: 68.1 years]) to investigate the early effects of treatment by monthly MIN or RIS over a 4-month period using bone turnover marker values. Only female patients were enrolled to avoid gender bias. Urinary cross-linked N-telopeptide of type I collagen (NTX) before treatment and at 1, 2, and 4 months of therapy, as well as serum bone alkaline phosphatase and alkaline phosphatase before treatment and at 4 months afterwards, were evaluated. All bone turnover marker values were significantly decreased at 4 months in both groups. The changes in urinary NTX at the study end point for RIS and MIN were -30.1% and -63.1%, respectively. From 2 months of treatment, the antiresorptive effects on urinary NTX by MIN were significantly higher than those by RIS, indicating that MIN more immediately and strongly inhibited bone absorption. Thus, monthly MIN seems to suppress bone resorption faster and more strongly than RIS in OP treatment.
Absorption ; Alkaline Phosphatase ; Bone Remodeling ; Bone Resorption* ; Collagen Type I ; Female ; Humans ; Osteoporosis ; Risedronate Sodium* ; Sexism

Objectives: Infective endocarditis (IE) has an extremely poor prognosis unless appropriate treatment is received. Hemodialysis patients with IE show higher rates of morbidity and mortality in comparison with non-dialysis patients with IE. We focused on hemodialysis patients, as well as patients in other stages of chronic kidney disease. We sought to assess the relationship between renal function and mortality in patients with IE.
Methods: We carried out a retrospective cohort study on 45 consecutive patients with IE in an urban teaching hospital between November 2003 and August 2008. We collected demographic and clinical data as well as pre- and post-discharge outcomes. Patients were subdivided into four groups according to their eGFR level at admission: A: eGFR≧60 ml/min/1.73 m² (n=23); B: eGFR 30-59 ml/min/1.73 m² (n=15); C: eGFR<30 ml/min/1.73 m² (n=3); and, D: dialysis patients (n=3). It was not possible to determine the outcome status of one patient. The Trend Test was used to evaluate the association between renal function and mortality.
Results: There were 29 male and 16 female patients with IE and the mean age was 67.9+-17.6 (SD). There were 10 diabetic patients (22%). Thirty-nine patients (84%) were either discharged or transferred to another hospital. Seven patients (16%) died: two (9%) Group A patients; three (20%) Group B patients; no Group C patients; and, two (67%) Group D patients. Patients with lower eGFR had higher mortality rates (Trend Test, P=0.046).
Conclusion: We presume a trend towards a higher mortality rate in conjunction with advancing CKD stage.