Introduction and Methods: An immediate effect of the physician shortage is the return to clinical work by physicians who had earlier left. Therefore, the needs of returning physicians were examined by means of a self-administered questionnaire. The subjects were clinicians working in Gunma Prefecture.
Results: About 50% of female physicians and 25% of male physicians had left clinical practice. The reasons given for leaving were “studying abroad” for most male physicians and “pregnancy and child-rearing” for most female physicians. More than 70% of physicians who had left clinical work felt uneasy about returning. The degree of anxiety after returning did not differ significantly between male and female physicians. Problems encountered by returning physicians involved “changes in medicines,” “changes and progress in technology and medical theories,” and deterioration of their “skills and techniques.” Moreover, returning physicians felt a need for increased “practical skills training.”
Discussion: Our study has clarified the needs of physicians returning to clinical work. The development and adoption of a simple system that will help physicians return to clinical practice is required.

Introduction: Lifelong learning is important for physicians because of patient safety and the need to constantly improve the quality of medical practice. However, few studies have investigated the specific topics that are required.
Methods: We examined the lifelong learning needs of physicians by means of a self-administered questionnaire that was completed by 595 subjects, who were clinical practitioners working in Gunma Prefecture.
Results: Subjects of all ages needed lectures about the use of evidence-based medicine in medical examinations, clinical studies and the interpretation of epidemiological data, and diagnostic imaging. The younger subjects had a greater need for learning about clinical skills and techniques, such as advanced cardiac life support／intensive care life support, abdominal ultrasonic diagnosis, and cardiac ultrasonic diagnosis. Regarding the ideal times for these lectures, some physicians working at Gunma University Hospital expressed a preference for weekdays after normal business hours, while others preferred the weekends.
Discussion: The lifelong learning needs of physicians were clarified. Because physicians work on different shifts and at different institutions, scheduling training sessions that everyone can attend is difficult, especially for those who are off-campus. The timing of the training sessions, as well as the content of lectures, must be considered. Ideally, sessions should be held more than once to accommodate the busy schedules of physicians. We believe that providing an opportunity for lifelong learning will help attract more people to a career in medicine and thereby help address the physician shortage.

Purpose: In Japan, only a few studies reported self-management systems of narcotic drugs among hospitalized patients. Our purpose was to develop a self-management system for patients and assess its effectiveness. Methods: Based on the results of a questionnaire administered to our hospital medical staff, methods of selecting eligible patients and methods of self-management of narcotic drugs were determined by a multi-professional team. Selection criteria for eligible patients were: 1) satisfactory results on assessment of the patient's ability to self-manage orally-administered drugs; 2) satisfactory results on assessment of the patient's ability to self-manage narcotic drugs; 3) physician's consent was obtained; and 4) the patient wanted to participate in this program. After the period of self-management of drug administration, questionnaires were distributed to the patients and medical staff in the general ward. Results: One hundred hospitalized patients used narcotic drugs between April 2008 and March 2009. Among them, 26 patients met the criteria for self-management of narcotic drugs, and 20 voluntarily participated in the program. There were no reports of missing or stolen drugs. There were no reports of administration of incorrect dose of the drug during the self-management period (average 15.0 days). Ninety-four percent of the self-managing patients provided positive feedback about self-management of narcotic drugs, such as mental stability by having drugs on hand and no problems in self-management. Seventy-five percent of staff members answered that the self-management system of narcotic drugs should be continued. Conclusion: Our results suggest that this system of narcotic drug self-management is safe and appropriate. Palliat Care Res 2010; 5(1): 114-126

We experienced a difficult case which had multiple impairments caused by antiphospholipid syndrome. This disease is a thrombophilic disorder in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies (e.g. anticardiolipin antibody, lupus anticoagulant). This disease is well demonstrated as a cause of ischemic stroke in young adults. But the optimal treatment of these patients is unclear, and their prognosis is not good. Antiphospholipid syndrome causes recurrent multiple ischemic strokes, induces severe impairments and the disturbance of various higher brain functions, and shows resistance against rehabilitation. To address these difficulties we should, as rehabilitation experts, conduct chronic disease-management with the cooperation of the neurologists, and devise a rehabilitation approach that takes into consideration the nature and severity of this disease. In other words, a diversified approach, which is characteristic to rehabilitation, is no less important than medical remedies in treating antiphospholipid syndrome patients.

The purpose of this study was to determine daily steps corresponding to the reference value for the quantity of Physical Activity and Exercise for Health Promotion 2006 (23 METs·h/wk) considering non-locomotive activities. Two hundred and thirty one men and 224 women wore a tri-axial accelerometer for two weeks. We analyzed the data in each age group (young (less than 40 years), middle-aged (40 to 59 years), and elderly (60 years or more) groups), also. There were significant relationships between daily steps and locomotive activity (r = 0.762 to 0.820, p < 0.001) and total (locomotive and non-locomotive) physical activity (r = 0.706 to 0.824, p < 0.001) with intensity of 3 METs or more in all groups. The daily steps corresponding to 23 METs·h/wk, calculated using regression lines between the daily steps and total physical activities with intensity of 3 METs or more in men and women were 6,534 steps/d and 6,119 steps/d. On the other hand, the daily steps corresponding to 23 METs·h/wk, calculated using regression lines between the daily steps and locomotive activities with intensity of 3 METs or more in men and women were 7,888 steps/d and 8,584 steps/d. These results suggest that non-locomotive activity should also be taken into consideration in the case of assessment of a daily physical activity.

1）Palliative care education by means e–learning was performed from December 3 to 25, 2009, for 1256 hospital medical staff. We used the same true–or–false questions to assess their understanding before and after the e–learning course.
2）Regardless of the staff member’s experience, the total scores on the test were higher after the course than before the course. Therefore, this e–learning course had an effect on basic knowledge for multiple types of medical staff.
3）The percentage of correct answers was particularly improved for questions about topics we had emphasized: drug dependence and side effects.

　　Hyperbaric oxygen (HBO) therapy for acute carbon monoxide (CO) poisoning is performed after oxygen therapy and breathing therapy. The usefulness of HBO therapy in emergency treatment has been reported. In this study, we examined the effectiveness of HBO for CO poisoning that was performed at our hospital over the past 5 years. Subjects were 23 patients who had HBO therapy for CO poisoning in the period January 2008-November 2013. The male to female ratio of the cases was 14:9 and the mean age was 54.6±20.8 years. The cause was suicide in 39.1% of cases and accident in 60.9%. The mean number of treatments was 5.4±6.8. The atmosphere absolute was 2ATA:2.8ATA=12:11. The ratio of direct conveyance of the patient to our hospital to indirect conveyance of the patient from another hospital was 15:8. The effectiveness of HBO therapy at the time of discharge was 73.9%. However, delayed neuropsychiatric sequelae (DNS) was detected in 3 of the 23 cases of CO poisoning. No correlations were found between elapsed time after CO inhalation and various blood parameters. However, time to start of therapy is important for DNS, and our results suggest that early treatment at a hospital with a hyperbaric chamber is necessary.

BACKGROUND/AIMS: The present study aimed to clarify whether virological response within 2 weeks after therapy initiation can predict a null response to pegylated interferon alpha-2b plus ribavirin therapy in patients with high viral load genotype 1b hepatitis C. METHODS: The participants consisted of 72 patients with high viral load genotype 1b. The dynamics of viral load within 2 weeks were measured. RESULTS: Significant differences between null responders and nonnull responders were noted for interleukin (IL)-28B genotype, amino acid 70 substitution, alpha-fetoprotein, low-density lipoprotein cholesterol, hyaluronic acid, and viral response. The area under the curve (AUC) for the receiver operating characteristic curve of the hepatitis C virus (HCV) RNA level decline at 2 weeks (AUC=0.993) was the highest among the factors predicting the null response. When the cutoff value for the HCV RNA level decline at 2 weeks was set at 0.80 log, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting a null response were 82%, 96%, 82%, 96%, and 94%, respectively. In comparison, values for the non-TT and mutant type of amino acid 70 substitution were similar to those for HCV RNA level decline at 2 weeks. CONCLUSIONS: Virological response at 2 weeks or the combination of IL-28B and amino acid 70 substitution are accurate predictors of a null response.
Administration, Oral ; Adult ; Aged ; Antiviral Agents/*administration & dosage ; Area Under Curve ; Drug Therapy, Combination ; Female ; Genotype ; Hepatitis C, Chronic/*drug therapy/genetics ; Humans ; Injections, Subcutaneous ; Interferon-alpha/*administration & dosage ; Male ; Medication Adherence ; Polyethylene Glycols/*administration & dosage ; Prospective Studies ; RNA, Viral/metabolism ; Recombinant Proteins/administration & dosage ; Ribavirin/*administration & dosage ; Treatment Outcome ; Viral Load ; Young Adult

Objective: The package inserts are official clinical decision-making documents that provide pharmacological treatment information. However, it has been noted that package inserts on perinatal drug usage differ greatly from expert opinions. This study identified Japanese package insert drugs that are contraindicated for pregnant women and compared them to foreign risk categories.Methods: The survey included 19,022 drugs on the drug pricing list as of April 2022, with package inserts available on the Pharmaceuticals and Medical Devices Agency website. We retrieved the package inserts with the word “pregnant” in the “Contraindications” section and reviewed the descriptions to exclude those that satisfied the exclusion criteria. We also checked the foreign risk categories of contraindicated ingredients for pregnant women. This study used the Australian Therapeutic Goods Administration’s categorization for prescribing medicines in pregnancy (the TGA classification).Results: Of the 19,022 medicines studied, 4,111 (21.6%) were contraindicated for pregnant women. Conversely, 19 (5.1%) ingredients categorized under the relatively safe TGA classifications A, B1, and B2 were also contraindicated for pregnant Japanese women.Conclusion: This study revealed that Japanese package inserts contraindicate over 20% of drugs for pregnant women. On the other hand, some forbidden ingredients did not match the foreign risk categories. Therefore, healthcare professionals should be aware of the limitations of Japanese package inserts concerning pregnant women and make careful decisions based on both package inserts and additional drug information.