Objective: Instructions contained in over-the-counter medicine package inserts can be hard to read because of the limited printing space.  Pictograms are one means of helping users to understand important information.  However, few pictogram systems have been reliably and validly evaluated.  Therefore, a new method was developed to improve the clarity of each illustration and the legitimacy as a pictogram for conveying information important.
Methods: Four creators developed 69 illustrations, each of which expressed one of 24 instructions in the package insert of an H2 blocker.  In a survey, participants (449 university undergraduate and graduate students and 103 pharmacy users) were asked to describe the possible meaning of each illustration and to provide their personal suggestions for improvement.  To evaluate comprehension of information, each instruction was broken into two or three different parts.  Comprehension level was calculated by: (number of people who answered correctly) × 100 / (total number of respondents).  Existing pictograms were included to compare comprehension levels for the same instructions.
Results: Using 67% as the minimum standard for comprehension, we classified each illustration into one of three categories: “no need for improvement,” “need for partial improvement,” and “need for total improvement.”  The students and pharmacy users tended to accurately interpret the possible meanings of illustrations that were familiar to them.
Conclusion: Breaking one instruction of the package insert into a few important pieces of information was useful for determining the level of improvement needed for each illustration.  Evaluating how well each illustration conveys important information in the instructions through two steps was also beneficial, which are to improve the illustration’s clarity with students and its legitimacy among pharmacy users for fulfilling the intended functions of a pictogram.

Limited evidence was available to support the effect of self-selected activities performed under free-living conditions on postprandial lipaemia, particularly for older adults. Thus, the aim of the present study was to examine the chronic effect of increased physical activity of daily living on postprandial triacylglycerol (TAG) in postmenopausal women. Twenty-eight postmenopausal women, aged 71 ± 4 years (mean ± SD), were randomly divided into two groups: active (n=14) and control (n=14) groups. The participants in the active group were asked to increase their activities above their usual lifestyle levels for 4 weeks; freely deciding the duration and intensity of their chosen activities. The participants in the control group maintained their usual lifestyle for 4 weeks. All participants were asked to wear a uniaxial accelerometer for 4 consecutive weeks. At baseline and after 4 weeks, all participants rested and consumed a standardised breakfast and lunch after a 24-h period of physical activity avoidance. Blood samples were collected in the fasted state (0 h) and at 2, 4 and 6 h after breakfast. After 4 weeks, the participants in the active group increased their step counts by 600 steps/day (from 6979 ± 2057 to 7586 ± 2301 steps/day, p=0.047). There was no difference in the pattern of postprandial TAG response between groups (trial × time interaction, p=0.335). A previous study has suggested that only recent exercise (i.e., 12h before but not 24 h before) appears to facilitate the exercise-induced postprandial TAG lowering effects. Thus, in the present study, postprandial lipaemia was not reduced after performing self-selected activities under free-living in postmenopausal women.

Purpose : To examine the characteristics of second-year residents intending to become primary care physicians.
Methods : Using a self-administered questionnaire, we surveyed 7344 second-year residents in March, 2006. Of the 4167 responders (response rate 56.7%), the 3838 who answered that they intended to make a career choice of being clinical practitioners were taken as subjects for analysis. The odds ratios (OR) for the intention of being a primary care physician was calculated, together with the 95% confidence interval (95% CI), using logistic regression models (primary care physicians intended=1 vs. specialist intended=0)
Results : In total, 56% of the residents affirmed an interest in becoming primary care physicians. Multiple stepwise logistic models showed that residents intending to become primary care physicians planned to open their own clinics in the future (OR 1.44, 95% CI : 1.20-1.73), did not wish to obtain doctor of medical science (DMSc) degrees (OR 1.29, 95% CI : 1.07-1.55), and were more likely to choose internal medicine (OR 1.44, 95% CI : 1.07-1.94).
Conclusion : This study demonstrated that second-year residents who aimed to be primary care physicians were associated with more interest in opening private clinics for their future practice, preferably in the field of internal medicine, and with less interest in earning DMSc degrees.

Videotape feedback reportedly improves communication skills in students learning to conduct medical interviews. We carried out a study of videotape feedback in the undergraduate training program of the department of neuropsychiatry. To evaluate the interviews, we used objective structured clinical examinations and feedback from interviewed patients. The students showed several shortcomings, such as passive investigation into symptoms, past history, family history and explanatory models; poorly expressed empathy; unclear summation; poor explanation about what interviewees should do after the interview; and infrequent use of specific probes and silence skills. Feedback from patients was more favorable than that from instructors. Because our program asking psychiatric patients to participate as interviewees seems to have both advantages and disadvantages, using simulated patients would be helpful for examining the validity of our program.

No abstract available.
Arthritis, Rheumatoid* ; Histiocytosis* ; Humans

High-quality terminal care cannot be given without good communication and understanding among patients, their family members and health as well as medical professionals.Recently, we have taken a questionnaire survey on new inpatients in our hospital to sound them out on their thinkings about hospital care, and examined the findings along with the validity of survey.Many respondents including those contracting either benign or malignant diseases wished to be keptposted on what they are really up against and to partake in the decision-making process before treatment plans are put into practice. The recent questionnaire survey has proved to be worthwhile as a tool to know the wishes of hospitalized patients and suggested an effective way to promote the practice of obtaining informed consent before specific test and therapautic procedure.

Objective: We investigated the efficacy and toxicity of tailored-dose chemotherapy with gemcitabine and irinotecan for platinum-refractory/resistant ovarian or primary peritoneal cancer. Methods: We enrolled patients with ovarian or primary peritoneal cancer who received ≥2 previous chemotherapeutic regimens but developed progressive disease during platinumbased chemotherapy or within 6 months post-treatment. All patients received gemcitabine (500 mg/m 2 ) and irinotecan (50 mg/m 2 ) on days 1 and 8 every 21 days at the starting dose. The dose was increased or decreased by 4 levels in subsequent cycles based on hematological or non-hematological toxicities observed. The primary endpoint was progression-free survival (PFS), and secondary endpoints were disease control rate (DCR), overall survival (OS), and adverse events. Results: We investigated 25 patients who received 267 cycles (median 8 cycles/patient) between October 2008 and May 2011. Tailored-dose gemcitabine was administered up to the 5th cycle as follows: 1,000 mg/m 2 in 1 (4%), 750 mg/m 2 in 16 (64%), 500 mg/m 2 in 6 (24%), and 250 mg/m 2 in 2 patients (8%). The median PFS and OS were 6.2 months (95% confidence interval [CI]=2.7–10.7) and 16.8 months (95% CI=9.4–30.7), respectively. The DCR was 76%, and PFS was >6 months in 12 of 25 patients (48%). Grade 3 hematological toxicities included leukopenia (9.4%), neutropenia (11.2%), anemia (9.8%), and thrombocytopenia (1.1%).Grade 3/4 non-hematological toxicities did not occur except for fatigue in one patient. Conclusions Tailored-dose chemotherapy with gemcitabine and irinotecan was effective and well tolerated in patients with platinum-refractory/resistant ovarian or primary peritoneal cancer.

This study is based on the investigation of Japanese ancient experienced agricultural techniques and historical and current exploration of strain and morphology of plants. We aim to dig up the tacit knowledge, which can guarantee the quality of production and profitability when they are applied for current medicinal plant cultivation. We focused on Paeonia lactiflora Pallas as the candidate of the farming products for the vitalization of mountainous area. Bon-ten (with white double-petaled flowers) is considered to produce highly qualified Paeoniae Radix in medical practice. We found several strains of the plant source different from Bon-ten as the origin of Yamato-Shakuyaku, bred after TOKUGAWA Yoshimune’s policy promoting the domestic cultivation of medicinal plants in Edo period. These strains include the cultivar with red single-petaled flower, which is drawn in ‘Matsuyama-Honzo’ by Morino Tosuke-Saikaku, who established private herb garden, ‘Morino herbal garden,’ supported by Tokugawa shogunate. Among Morino family documents, we also found the unpublished historical papers suggesting the various productions of crude drugs at Yamato region in Edo period, and considered the transition of domestic production area, cultivation strains and cultivation skills. We can find the descriptions of picking of buds and flowers among current production manuals, but it is suggested the possibility of flowers for ornamental or commercial use to improve economic efficiency by the investigation of regional cultures and interviews of experts of crude drugs.

OBJECTIVES: The number of patients with bilateral cochlear implant (CI) has gradually increased as patients and/or parents recognize its effectiveness. The purpose of this report is to evaluate the efficacy of 29 bilateral CI out of 169 pediatric CI users, who received auditory-verbal/oral habilitation at our hearing center. METHODS: We evaluated the audiological abilities 29 Japanese children with bilateral CIs including wearing threshold, word recognition score, speech discrimination score at 1 m from front speaker (SP), 1 m from second CI side SP, speech discrimination score under the noise (S/N ratio=80 dB sound pressure level [SPL]/70 dB SPL, 10 dB) at 1 m from front SP, word recognition score under the noise (S/N ratio=80 dB SPL/70 dB SPL, 10 dB) at 1 m from front SP. RESULTS: Binaural hearing using bilateral CI is better than first CI in all speech understanding tests. Especially, there were significant differences between the results of first CI and bilateral CI on SDS at 70 dB SPL (P=0.02), SDS at 1 m from second CI side SP at 60 dB SPL (P=0.02), word recognition score (WRS) at 1 m from second CI side SP at 60 dB SPL (P=0.02), speech discrimination score (SDS) at 1 m from front SP under the noise (S/N=80/70; P=0.01) and WRS at 1 m from front SP under the noise (S/N=80/70; P=0.002). At every age, a second CI is very effective. However, the results of under 9 years old were better than of over 9 years old on the mean SDS under the noise (S/N=80/70) on second CI (P=0.04). About use of a hearing aid (HA) in their opposite side of first CI, on the WRS and SDS under the noise, there were significant differences between the group of over 3 years and the group of under 10 months of HA non user before second CI. CONCLUSION: These results may show important binaural effectiveness such as binaural summation and head shadow effect. Bilateral CI is very useful medical intervention for many children with severe-to-profound hearing loss in Japan as well as elsewhere.
Asian Continental Ancestry Group ; Child ; Cochlear Implantation ; Cochlear Implants ; Head ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Japan ; Noise ; Parents ; Speech Perception

The treatment by Kampo decoction is partly covered by National Health Insurance in Japan. However, this system is facing bankruptcy crisis because of rising prices of crude drugs in China, their main producer. The board of crude drug materials of the Japan Society for Oriental Medicine (JSOM) distributed questionnaires to 7416 JSOM member doctors, and performed statistical analysis (with JSOM approval) of 1877 answers to visualize the data. Twenty-six percent of respondents said that they had prescribed a decoction, and 29% of respondents said they had not, but wanted to prescribe a crude drug. Eighty-eight percent of doctors who prescribe decoctions offered medical treatment primarily to insured patients. Nine percent offered medical treatment at patients' own expense. The latter group prescribed decoctions more frequently. Many doctors were aware of the financial risk of prescribing crude drugs imposed by the drug price standard and rising crude drug import prices. Four hundred and fifty­-five doctors explained when they were most inclined to prescribe a decoction. Thirty-five percent of these said they used decoctions when they couldn't treat patients with extracts. This result implies a necessity for decoctions. Many doctors said they prescribed decoctions for autoimmune or allergic diseases. Financial constraints were the most frequently cited barrier to treatment with decoctions. This survey made clear the financial difficulties clinics are facing. We therefore calculated the amount of crude drugs used for decoctions to validate the possibility of their domestic production.