In the medical interview portion of the objective structured clinical examination (OSCE), we usually use both detailed checklists and a global rating scale to evaluate a student's performance. In the present study we investigated a problem with the detailed checklists.
1) The quality of the assessment of information-gathering capability was investigated in a station for the medical interview in a pharmaceutical OSCE.
2)A video review revealed a 7% error in the detailed checklist assessment at the OSCE station.
3) Following the interview in this study, the students wrote down the information they had gathered. These results differed by 15.6% from those of the detailed checklist assessment at the OSCE station.
4) In the present style of OSCE, the detailed checklist assessment at the OSCE station is problematic. The style in which the students write down the gathered information after the interview might be re-considered.

1) We compiled lists of accredited training hospitals for postgraduate education from the matching program list and of hospitals that employ board-certified specialists in emergency medicine.We then evaluated the number of training hospitals that employ board-certified specialists.
2) There are 1072 accredited hospitals for postgraduate education. However, only 546 (50.8%) of these hospitals employ board-certified specialists in emergency medicine.
3) Accredited training hospitals with emergency-medicine specialists are prevalent in Okinawa, Tokushima, and Kagawa prefectures.However, the prevalence of these hospitals is surprisingly low in metropolitan areas.

Qualitative research has gained greater attention in medical research, but it might seem to be unscientific because qualitative and quantitative research methods are grounded in different paradigm.
In this article, we introduce three major qualitative research methods frequently used in studies of patient-doctor communications: 1) in-depth interviews; 2) focus group interviews and, 3) semi-structured interviews.
Each qualitative research method has different or common advantages and disadvantages, and which methods should be used depends on the study objectives. Qualitative research and quantitative research are complementary: while quantitative research explains the prevalence or variation of an issue, qualitative research explains the reasons or processes of that prevalence or variation. Combination of the two methods enables the gathering of more comprehensive and explanatory results.

  We describe a prototype seminar, inspired by the problem-based learning tutorial system, on pediatric emergency practice for young physicians working in 7 pediatric emergency centers in Yokohama. The seminar was received favorably by the participants, especially as an opportunity for individual learning. We expect that the seminar will contribute to the standardization of emergency practice in these pediatric centers and the establishment of an interhospital network.

Anomalous origin of the coronary artery is rare. Various complications have been reported in patients with this anomaly undergoing heart valve surgery. We describe a case of aortic valve stenosis combined with an anomalous origin of the left coronary artery. An 84-year-old man with exertional dyspnea was referred for surgical treatment of severe aortic valve stenosis. Coronary angiography and computed tomography of the coronary artery revealed a coronary arterial anomaly : the left anterior descending coronary artery originated as a branch of the right coronary artery, and the left circumflex artery separately originated from the right coronary sinus and extended behind the aortic annulus. To prevent injury to the anomalous circumflex artery during surgery, the artery was separated from the fatty tissue around the aortic annulus and dissected free from the aortic wall before the performance of transverse aortotomy. The coronary artery exhibited a single orifice that was significantly enlarged. Whether antegrade infusion of the cardioplegic solution could be achieved was difficult to determine. To perform the retrograde infusion, the catheter tip was inserted directly into the coronary sinus from the epicardium because the orifice in the right atrium was lattice-like. Aortic valve replacement was successfully performed with supra-annular prosthesis insertion using a 19-mm Mosaic porcine valve (Medtronic, Minneapolis, MN, USA). The postoperative course was uneventful. When aortic valve replacement is performed for patients with an anomalous coronary artery, careful performance of operative procedures and postoperative observation are considered important for the prevention of specific perioperative complications, such as intraoperative coronary injury or postoperative myocardial ischemic events in patients with an anomalous left circumflex artery.

Objective: Previously, we reported that insulinoma-associated protein 1 (INSM1) immunohistochemistry (IHC) showed high sensitivity for neuroendocrine carcinoma of the uterine cervix and was an effective method for histopathological diagnosis, but that its specificity remained to be verified. Therefore, the aim was to verify the specificity of INSM1 IHC for a large number of non-neuroendocrine neoplasia (NEN) of the cervix. Methods: RNA sequences were performed for cell lines of small cell carcinoma (TCYIK), squamous cell carcinoma (SiHa), and adenocarcinoma (HeLa). A total of 104 cases of formalin-fixed and paraffin-embedded specimens, 16 cases of cervical NEN and 88 cases of cervical non-NEN, were evaluated immunohistochemically for conventional neuroendocrine markers and INSM1. All processes without antigen retrieval were performed by an automated IHC system. Results: The transcripts per million levels of INSM1 in RNA sequences were 1505 in TCYIK, 0 in SiHa, and HeLa. INSM1 immunoreactivity was shown only in the TCYIK. Immunohistochemical results showed that 15 cases of cervical NEN showed positive for INSM1; the positivity score of the tumor cell population and the stain strength for INSM1 were high. Two of the 88 cases of cervical non-NENs were positive for INSM1 in one case each of typical adenocarcinoma and squamous cell carcinoma. The sensitivity of INSM1 for cervical NEN was 94%; specificity, 98%; the positive predictive value, 88%; and the negative predictive value, 99%. Conclusion INSM1 is an adjunctive diagnostic method with excellent specificity and sensitivity for diagnosing cervical NEN. Higher specificity can be obtained if morphological evaluation is also performed.

Background/Aims: The use of endoscopic intervention (EI) for acute biliary pancreatitis (ABP) remains controversial because the severity of biliary obstruction/cholangitis/pancreatitis is not reflected in the indications for early EI (EEI). Methods: A total of 148 patients with ABP were included to investigate 1) the differences in the rate of worsening cholangitis/pancreatitis between the EEI group and the early conservative management (ECM) group, especially for each severity of cholangitis/pancreatitis, and 2) the diagnostic ability of imaging studies, including endoscopic ultrasound (EUS), to detect common bile duct stones (CBDSs) in the ECM group. Results: No differences were observed in the rate of worsening cholangitis between the EEI and ECM groups, regardless of the severity of cholangitis and/or the existence of impacted CBDSs. Among patients without impacted CBDSs and moderate/severe cholangitis, worsening pancreatitis was significantly more frequent in the EEI group (18% vs. 4%, p=0.048). In patients in the ECM group, the sensitivity and specificity for detecting CBDSs were 73% and 98%, respectively, for EUS, whereas the values were 13% and 92%, respectively, for magnetic resonance cholangiopancreatography. Conclusions EEI should be avoided in the absence of moderate/severe cholangitis and/or impacted CBDSs because of the high rate of worsening pancreatitis. EUS can contribute to the accurate detection of residual CBDSs, for the determination of the need for elective EI.

BACKGROUND/AIMS: There is no consensus for using endoscopic papillary large balloon dilation (EPLBD) in patients without dilatation of the lower part of the bile duct (DLBD). We evaluated the feasibility and safety of EPLBD for the removal of difficult bile duct stones (diameter ≥10 mm) in patients without DLBD. METHODS: We retrospectively reviewed the records of 209 patients who underwent EPLBD for the removal of bile duct stones from October 2009 to July 2014. Primary outcomes were the clearance rate and additional mechanical lithotripsy. Secondary outcomes were the incidence of complications and recurrence rate. RESULTS: Fifty-seven patients had DLBD (27.3%), and 152 did not have DLBD (72.7%). There were no significant differences in the overall success rate or the use of mechanical lithotripsy. Success rate during the first session and procedure time were better in the DLBD than the without-DLBD group (75.7% vs 66.7%, 48.1±23.0 minutes vs 58.4±31.7 minutes, respectively). As for complications, there were no significant differences in the incidence of pancreatitis, perforation or bleeding after endoscopic retrograde cholangiopancreatography. The recurrence rate did not differ significantly between the two groups. CONCLUSIONS: EPLBD is a useful and safe method for common bile duct stone removal in patients without DLBD.
Bile Ducts* ; Bile Ducts, Extrahepatic* ; Bile* ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Consensus ; Dilatation* ; Hemorrhage ; Humans ; Incidence ; Lithotripsy ; Methods ; Pancreatitis ; Recurrence ; Retrospective Studies

In the areas of home medical care and self-medication, the role of the pharmacist is growing, partly as a result of Japan’s aging society and the need to reduce medical costs. In response, the Kinki University Faculty of Pharmacy implemented a physical assessment practical training seminar in order to improve the physical assessment skills of practicing pharmacists. A series of questionnaires were conducted among pharmacists to investigate their perceptions of physical assessment practical training seminars. The results of the questionnaires were analyzed using Customer Satisfaction (CS) analysis and text mining. Based on a 5-point scale (1-low∼5-high), questionnaires revealed satisfaction for physical assessment practical training seminars was 4.6±0.6 (Ave.±S.D.). CS analysis revealed that the items “lectures” and “case seminars” had the highest level of satisfaction. However, items showing low levels of satisfaction were “auscultation of respiratory sounds” and “SBAR (Situation, Background, Assessment, Recommendation).” Results of text mining suggested a relationship between “physical assessment” and “difficult”. Analysis of the questionnaires showed a high level satisfaction with physical assessment practical training seminars, notably physical assessment practice methods. However, CS analysis and text mining indicate the finer techniques of physical assessment were difficult to acquire.

BACKGROUND/AIMS: There are few reports on the correlation between chewing gum and the gastrointestinal functions. But previous report showed use of chewing gum to be an effective method for controlling gastrointestinal symptoms. The aim of this study was to determine the correlation between chewing gum and gastric emptying using the continuous real time 13C breath test (BreathID system). METHODS: Ten healthy male volunteers participated in this randomized, 2-way crossover study. The subjects fasted overnight and were randomly assigned to chewing gum (Xylish, 2-3/1 tablet) for an hour following intake of a test meal (200 kcal/200 mL) or intake of the test meal alone. Gastric emptying was monitored for 4 hours after administration of the test meal by the 13C-acetic acid breath test performed continually using the BreathID system. RESULTS: No significant differences in the calculated parameters, namely, T1/2 (median, 111.82 vs 109.26 minutes; P = 0.575), Tlag (median, 53.28 vs 56.53 minutes; P = 0.333), gastric emptying coefficient (median, 3.58 vs 3.65; P = 0.285), regression-estimated constant beta (median, 1.85 vs 1.80; P = 0.575) and regression-estimated constant kappa (median, 0.61 vs 0.62; P = 0.959) were observed between the test meal alone group and the test meal and chewing gum group. CONCLUSIONS: This study showed that chewing gum had no effect on the rate of gastric emptying. Therefore, since chewing gum did not enhance the speed of gastric emptying, it may ameliorate gastrointestinal symptoms through other mechanisms, such as saliva and autonomic nervous system.
Autonomic Nervous System ; Breath Tests ; Chewing Gum ; Cross-Over Studies ; Gastric Emptying ; Humans ; Male ; Mastication ; Meals ; Saliva