Introduction : The purpose of this study was to clarify the effectiveness of a home exercise (HE) program for hemophilic patients.
Methods : An intervention study was conducted over twelve weeks for patients aged 16 to 60 years, inclusive. Exercise guidance to assist in the improvement of their knee function was provided to the patients. Using questionnaires and assessments of physical function, we measured the physical condition of the patients before and after HE. Guidance about the strengthening of knee extensor muscles, static stretching of knee flexor muscles and standing balance training, as well as advice for the promotion of physical activities, was provided on an individualized basis. Muscle force and range of motion of the knee, modified Functional Reach (mFRT), 10 meter walking time, and 3 minute gait distance were all measured. All patients were surveyed for bleeding frequency, activities of daily living (ADL), and health related quality of life (HRQOL : SF-36), respectively.
Results : Twenty-two patients with an average age of 37.2 years, were included in the analysis, with 86.4% of them having a history of severe of hemophilia (coagulation factor level <0.01 IU mL−1). There were significant improvements in strength of knee extensor and range of extension of the knees, mFRT, 10 meter gait time, 3 minute gait distance, ADL, and physical function of SF 36. There was a significant correlation between Ex for locomotive activities and change of 3 minute gait distance. No increase in bleeding frequency was noted.
Conclusion : HE for hemophilic patients is useful for the improvement of muscle force and range extension of the knees, mFRT, gait speed, and ADL. Individualised guidance for improvement of physical activities and knee function is necessary for improvement of overall physical function.

A survey was performed to examine residents' awareness of patient safety. Sixty-two residents who had just finished their first year of residency participated in the study. Of the 62 residents, 30 were training at Yokohama City University Hospital and 32 were training at other hospitals. Although all residents knew about the serious medical mishap ( “surgical mix-up” ) that had occurred at Yokohama City University Hospital in 1999, only 53% knew about the judicial verdict in this case. The residents most often believed that the mishap was the fault of the hospital and its system (82%), followed by nurses (73%), supervising doctors (62%), and residents (45%). Seventy percent of the residents knew about the “Incident Reporting System, ” but only 20% had written an incident report. Incidents experienced or observed by residents were most often medication-related. No significant differences in the results of the survey were found between residents of Yokohama City University Hospital and those of other hospitals. In conclusion, although residents recognize the importance of patient safety at the end of the first year of their residency program, they still cannot deal properly with incidents.

　　A 48-year-old man with jaundice was referred to our hospital. Endoscopic retrograde cholangiography showed primary sclerosing cholangitis. Endoscopic biliary drainage was not successful because of highly viscous bile, so we performed percutaneous trans-gallbladder drainage (PTGBD), which was able to reduce the total serum bilirubin level from 8 to 10mg/ml. Subsequently, an indwelling drainage catheter was placed in the gallbladder for 13 months. However, liver atrophy worsened with the gradual progression of hepatic failure. Twelve months later, he complained of dyspnea. Computed abdominal tomography showed that the drainage catheter had perforated the diaphragm and become exposed to the chest cavity. In spite of intensive care, the patient died of liver failure while waiting for a liver transplant. Careful attention should be paid to the possibility of this serious complication in such patients.

Since the publication of To Err is Human in 1999, medical schools around the worldhave been discussing ways to teach medical students about patient safety. To deepen the understanding of patient-safety curriculums used in the United States, Dr. Matthew Weinger, director of the San Diego Center for Patient Safety and a professor at the University of California, San Diego, School of Medicine (UCSD), was invited to participate in around-table discussion on “Patient Safety Curriculum for Medical Students” held at Yokohama City University. Althoughthere have been active discussions in journals and within medical school faculties, no discernable consensus has emerged in the United States, other than that patient safety should become part of the educational system. The patient-safety curriculum used at UCSD and the curriculums promoted by the Department of Veterans' Affairs National Center for Patient Safety are introduced.

In autumn 2005, a 15-hour patient-safety education program was incorporated into the core curriculum for fourth-year medical students at the Yokohama City University School of Medicine. Sixty students took part in the program. The goals of the curriculum are for students to understand the prevalence and origins of medical errors and to increase awareness of the physician's responsibility for patient safety. Because typical learning methods, such as didactic lectures, might not be effective, we developed an experimental or case-based learning method. Educational modalities included small-group discussion of medical errors, role-playing of medical error disclosure, and experience operating infusion pumps. In addition, to bridge the gap between educational systems and hospital systems, we collaborated with other healthcare workers, such as nurses and hospital pharmacists. Students evaluated the program favorably; most recommended continuing the curriculum for future medical student classes.

A diagnosis of subepithelial tumors (SETs) is sometimes difficult due to the existence of overlying mucosa on the lesions, which hampers optical diagnosis by conventional endoscopy and tissue sampling with standard biopsy forceps. Imaging modalities, by using computed tomography and endoscopic ultrasonography (EUS) are mandatory to noninvasively collect the target’s information and to opt candidates for further evaluation. Particularly, EUS is an indispensable diagnostic modality for assessing the lesions precisely and evaluating the possibility of malignancy. The diagnostic ability of EUS appears increased by the combined use of contrast-enhancement or elastography. Histology is the gold standard for obtaining the final diagnosis. Tissue sampling requires special techniques to break the mucosal barrier. Although EUS-guided fine-needle aspiration (EUS-FNA) is commonly applied, mucosal cutting biopsy and mucosal incision-assisted biopsy are comparable methods to definitively obtain tissues from the exposed surface of lesions and seem more useful than EUS-FNA for small SETs. Recent advancements in artificial intelligence (AI) have a potential to drastically change the diagnostic strategy for SETs. Development and establishment of noninvasive methods including AI-assisted diagnosis are expected to provide an alternative to invasive, histological diagnosis.

Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients’ quality of life.

Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients’ quality of life.

Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients’ quality of life.

Peroral flexible endoscopy is a minimally invasive technique that enables the local resection of gastric subepithelial tumors (SETs) with malignant potential. Resection techniques are mainly chosen on the basis of the lesion size. Minute SETs less than 1 cm should be managed through a watch and wait strategy, with the exception of histologically diagnosed superficial lesions, which require endoscopic mucosal resection or endoscopic submucosal dissection. For 1- to 3-cm small SETs, endoscopic enucleation techniques, such as endoscopic submucosal excavation, submucosal tunneling endoscopic resection, and peroral endoscopic tumor resection, can be used. However, endoscopic full-thickness resection is preferred for histologically complete removal with negative surgical margins. When endoscopic full-thickness resection is considered technically difficult, laparoscopic and endoscopic cooperative surgery (LECS) is a safe and dependable alternative. Moderate-sized SETs (3 to 5 cm) require surgical intervention because the lesions must be removed transabdominally. LECS is a less invasive surgical procedure as it reduces the resection area; however, some LECS techniques that require transoral tumor retrieval are not available. Endoscopic intervention for lesions larger than 5 cm should be used with caution for research purposes. With advancements in endoscopic diagnosis, the indications for endoscopic treatment for SETs are expected to improve, thereby enhancing patients’ quality of life.