Introduction: We examined whether an intervention in students’ self-assessment causes behavioral changes in how they make their assessments.
Method: Students taking part in problem-based learning were divided into 2 groups. The students of Group 1 were asked to evaluate themselves with a four-step process, whereas the students of Group 2 students were asked to evaluated themselves and to indicate how confident they were that their self-assessments were consistent with assessments by their instructors.
Results: We observed a significant difference in self-assessment patterns between the groups. Students in Group 1 overestimated their abilities, whereas students in Group 2 underestimated their abilities. However, when we compared students’ self-evaluations and their grades in lecture courses, we found that students with low grades were more likely to overestimate their ability than were students with high grades, regardless of whether they had stated how confident they were in their assessments.
Discussion: By considering their degree of confidence that their self-assessments agreed with assessments by their instructors, students might show more careful assessment behavior. However, students with low grades require a greater degree of individual guidance before exhibiting behavioral changes.

We evaluated our undergraduate clinical clerkship system in 1992, using the multiplication method advocated by the Working Group on “Evaluation of clinical skills of medical students ” of the Japan Society for Medical Education. We divided the clinical training period into three terms: the first term was held from May through June, the second from September through October, and the third from December through January. We determined scores using checklists and rating scales in ten categories, totalled the scores for each period, and compared them between periods. The total scores for the third period were the highest, followed by those for the second period. Scores for basic knowledge, data gathering, and basic technical procedures increased with increase in the number of training hours. However, scores for manner, attitude, and interviewing skills were already high in the first period. We conclude that the multiplication method is useful for objectively evaluating students' clinical skills.

Objective: To develop and confirm the validity of a Biological Prognostic Score using only blood test results for prediction of prognosis in patients with advanced cancer. Methods: We conducted parametric survival time analysis using blood test results, age, sex, and primary diagnosis as independent variables, and event of death as a dependent variable, among patients in a palliative care unit (a development cohort). We then developed the Biological Prognostic Score (BPS). Thereafter, we confirmed the accuracy of the BPS and the Palliative Prognostic Index (PPI) prospectively among patients, who withdrew or withheld further curative or life-prolonging therapies, in other facilities (a validation cohort). Results: We developed the BPS, which consists of cholinesterase, blood urea nitrogen, and total iron-binding capacity, from 122 patients in a development cohort. We then examined 195 patients in a validation cohort and found that the area under the receiver operating characteristic curve for 1-9 week survival prediction was BPS=0.76-0.86 and PPI=0.69-0.73. Discussion: Our results suggest that the BPS was valid. It will be necessary to perform further examinations in multiple facilities and to explore more generalized parameters that could replace total iron-binding capacity in our BPS.

This is a case report of a 40-year-old man with leiomyosarcoma of the inferior vena cava. He had suffered from shortness of breath and edema on lower limbs over several months. Clinical examinations including UCG, CT and MRI revealed the mass in the right atrium. The stalk of mass was located near junction of the right atrium and inferior vena cava by cavography. He was operated upon using extracorporeal circulation. The tumor originated from inferior vena cava, measuring 8.5×5.5×4.8cm in size, 130g in weight, was successfully removed. Partial defect of anterior wall on the inferior vena cava was reconstructed using Gore-Tex patch. Histologically, the tumor was composed of the spindled cells with arranged bundles. Immunohistochemically, they were positive for Dessmin and Vimentin. Seven months after the surgery, he has been followed at OPD. In review of the Japanese literature to our knowledge, only 14 cases were reported including this case.

Background/Aims: We retrospectively analyzed Crohn’s disease (CD) patients with small intestinal strictures who underwent single-balloon enteroscopy (SBE) to ascertain whether prototype SBEs with a passive bending mechanism and high force transmission insertion tube had better insertability in the small intestine than a conventional SBE. Methods: Among 253 CD patients who underwent SBE, we identified 94 CD patients who had undergone attempted endoscopic balloon dilatation (EBD) for small intestinal stenosis for inclusion in this study. We analyzed whether the type of scope used for their initial procedure affected the cumulative surgery-free rate. For the insertability analysis, patients who underwent SBE at least twice were divided into 3 groups according to the type of scope used: conventional SBE only, prototype SBE only, and both conventional and prototype SBEs. For each group, depth of insertion, procedure time, and number of EBDs were compared in the same patient at different time points. Results: The success rate of EBD was 88.3%. The 5- and 10-year cumulative surgery-free rate was 75.7% and 72.8%, respectively. Cox regression analysis indicated that the factors contributing to surgery were long stricture (≥2 cm), EBD failure, and elevated Crohn’s Disease Activity Index, but not the type of scope used for EBD. The prototype SBEs significantly improved the depth of insertion (P=0.03, Wilcoxon’s signed-rank test). Conclusions In CD patients with small intestinal stenosis, the prototype SBEs with a passive bending mechanism and high force transmission insertion tube did not improve long-term EBD outcome but did improve deep insertability. (Clinical Trial Registration No. UMIN000037102)

Major bleeding associated with sagittal split ramus osteotomy (SSRO) involves vessels such as the inferior alveolar, facial, and maxillary arteries and veins, and the retromandibular vein (RMV). The present study aimed to clarify and classify the three-dimensional variations in RMV position and course direction in relation to the mandible. Specimens comprised a total of 15 scientific cadavers, and the relationship between RMV and the mandible lateral and posterior views was observed.We identified 3 patterns on the lateral view, the mean distance between the RMV and the posterior border of the ramus was 3.9 mm at the height of the lingula. A total of five course patterns were identified on the posterior view. In no course pattern, the RMV inferior to the lingula was lateral to its position superior to the lingual. The present findings suggest that it may be possible to predict correlations with intraoperative bleeding risk. Further study is planned using contrast computed tomography in patients with jaw deformity for skeletal classification.

BACKGROUND: Leukotriene receptor antagonists have been used to prevent virus-induced asthma exacerbations in autumn. Its efficacy, however, might differ with age and sex. OBJECTIVE: This study aimed to investigate whether pranlukast added to usual asthma therapy in Japanese children during autumn, season associated with the peak of asthma, reduces asthma exacerbations. It was also evaluated the effect of age and sex on pranlukast's efficacy. METHODS: A total of 121 asthmatic children aged 1 to 14 years were randomly assigned to receive regular pranlukast or not according to sex, and were divided in 2 age groups, 1–5 years and 6–14 years. The primary outcome was total asthma score calculated during 8 weeks by using a sticker calendar related to the days in which a child experienced a worsening of asthma symptoms. This open study lasted 60 days from September 15 to November 14, 2007. RESULTS: Significant differences in pranlukast efficacy were observed between sex and age groups. Boys aged 1 to 5 years had the lower total asthma score at 8 weeks (p = 0.002), and experienced fewer cold episodes (p = 0.007). There were no significant differences between pranlukast and control group in total asthma score at 8 weeks (p = 0.35), and in the days in which a child experienced a worsening of asthma symptoms (p = 0.67). CONCLUSION: There was a substantial benefit of adding pranlukast to usual therapy in asthmatic children, especially in boys aged 1 to 5 years, during autumn season.
Asian Continental Ancestry Group ; Asthma ; Child ; Child, Preschool ; Humans ; Leukotriene Antagonists ; Seasons

Context: Delirium in cancer is often difficult to control and refractory when haloperidol is invalid which is considered standard therapy. We need second and subsequent-line therapy to reduce hyperactivity and not to over-sedation for refractory delirium. Objectives: To investigate the efficacy and safety of continuous subcutaneous infusion chlorpromazine on delirium refractory to first-line antipsychiatric medications in advanced cancer palliative care setting. Method: The study population consisted of patients who received continuous subcutaneous infusion chlorpromazine for delirium at two certified PCU. Primary endpoint was the proportion of patients who showed improvements in delirium severity by Delirium Rating Scale Revised 98 score of less than 13 or decrease from baseline and maintained the ability to communicate coherently by Communication Capacity Scale Item-4 score of 2 or less. Secondary outcome were the Nursing Delirium Screening Scale subscale score, and injection site reactions evaluated according to the Common Terminology Criteria for Adverse Events. These outcome measures were assessed at baseline, 48 hours and 7 days after the start of the study. Result: Among eighty-four patients, sixty were positive responders (71.4%, 95% CI [61–80]). The mean CCS Item-4 scores significantly decreased from the baseline value of 1.48 (range 0–3) to 1.03 (range 0–3) at post-treatment (p<0.001). Grade 2 or higher injection site reactions were observed in 1 patient (1.2%, 95% CI [0–7]). Conclusion: Our study suggested that continuous subcutaneous infusion chlorpromazine could improve refractory delirium symptoms and patients’ communication capabilities. Although most of the skin disorders observed in association with chlorpromazine were mild, their incidence rates were relatively high, suggesting the need for careful monitoring.