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.

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.

In the present study, the effects of bulb type palatal lift prosthesis (bulb-PLP) therapy on nasality and velopharyngeal function (VPF) of patients with velopharyngeal incompetence (VPI) following palatoplasty were longitudinally assessed.The subjects included 18 patients (3 to 52 years of age) who had shown persistent VPI following palatoplasty and who had received bulb-PLP therapy. Nasality and VPF were assessed by perceptual voice analysis, nasometer test, blowing test, and cephalometric radiographic examination. Based on the outcomes of bulb-PLP therapy, the subjects were classified into two groups: the effective group and the ineffective group. Furthermore, the obturating and VPF-activating effects by bulb-PLP therapy were analyzed, and factors relating to different VPF activities were determined.All subjects achieved adequate VPF by wearing a bulb-PLP. After treatment, 10 patients (55.6%) achieved successful activation of VPF without bulb-PLP (the effective group), while persistent VPI remained in 8 patients (the ineffective group). The beginning-blowing ratio of the effective group was significantly greater than that of the ineffective group (P < 0.05) and the velopharyngeal distance (V-P distance) of the effective group tended to be smaller (P = 0.07). Regarding the shape of the bulb head, the angular type was dominant in the ineffective group, while the round type was dominant in the effective group.Bulb-PLP therapy was useful for providing adequate VPF activation. Possible signs of the subsequent effective activation of VPF are considered to be: 1) preexisting adequate VPF on blowing, 2) smaller V-P distance, and 3) synchronized palatopharyngeal movement.

Objective: This study aimed to elucidate the electro-clinical characteristics of epilepsy and immunological markers in patients with epilepsy after infl uenza-associated encephalopathy/encephalitis (IAE). Methods: Eighteen patients with epilepsy after IAE (8 males, 10 females; mean age of onset 6.4±6.4 years) were studied. Antibodies to glutamate receptor (GluR) ε2 (NR2B) were examined by immunoblot and ELISA. Cytokines were measured by BioPlex. Results: Mean interval between IAE and epilepsy onset was 63.2 ± 95.0 days (mean ± SD). In 16 of 18 patients, complex partial seizures were observed. Most complex partial seizures were of short durations and showed few lateralizing signs. Interictal discharges were seen in the frontal area in 7 of 14 patients. Ictal EEG showed rapid propagation to bilateral hemispheres. Patients with higher cerebrospinal fl uid levels of anti-GluRε2 antibodies, higher cerebrospinal fl uid levels of IL-1β, soluble tumor necrosis factor receptor 1 and IFN-γ during chronic stage, had higher frequency of epileptic seizures. Conclusion: This study indicates that the frontal lobes are susceptible to rapid epileptogenesis after IAE, and that epileptic partial seizures after IAE had characteristics resembling generalized seizures. Presence of anti-GluRε2 antibodies and elevated IL-1β, TNFα, and IFN-γ in cerebrospinal fl uid may be associated with intractability of epileptic seizures.

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.

Essential thrombocythemia is considered one of the chronic myeloproliferative disorders resulting in arterial thromboembolism, venous thrombosis, and bleeding tendency. We report a case of left ventricular aneurysm with successful treatment of the complications of this disease. A 66-year-old man who suddenly experienced right upper limb paralysis was carried to a nearby hospital. Computed tomography revealed multiple cerebral infarctions. An electrocardiogram confirmed findings of old myocardial infarctions in the anteroseptal wall. Echocardiography indicated a left ventricular aneurysm with mobile thrombus. The blood tests showed an abnormally high platelet count of 120×104/μl. His left ventricular thrombus showed an increasing tendency regardless of heparin administration ; thus, he was transferred to our hospital. The resection of the aneurysm and left ventricular restoration was performed emergently to avoid re-embolism. There was a soft thrombus inside the aneurysm at its apex. During cardiopulmonary bypass, the activated clotting time was not prolonged easily. We gave additional heparin and antithrombin III. The patient had no problem with hemostasis or postoperative bleeding. We started low-molecular-weight heparin from the second postoperative day and he was diagnosed with essential thrombocythemia by bone marrow biopsy. We started warfarin and aspirin on the fifth day after surgery. The number of platelets increased to 183×104/μl on the 8th day ; thus, oral administration of hydroxycarbamide was started. His platelet count fell to less than 100×104/μl around 3 weeks after surgery and he was discharged on the 34th day without new embolisms.

Real-world data (RWD), such as a health insurance claim database and electronic medical record database, which records daily medical care information, is one of the most important data sources in pharmacoepidemiological studies. In Japan, a post-marketing database study has been added as a new category of post-marketing surveillance since April 2018. It is expected that the post-marketing database studies will be conducted in the actual risk management plan； however, at this point, few have reached the stage of publishing study results. On the other hand, overseas, many database research results using RWD have already been reported. Although it is necessary to keep in mind that there are differences in the characteristics of the databases (e.g., data contents, structures) and the differences in the medical environment between overseas and Japan, we think that critically reviewing these reports has a reference value for the planning, execution, and interpretation of the results in performing post-marketing database studies in Japan. The purpose of this report is to examine the characteristics and cautions of the database studies through a critical review of published articles of overseas RWD studies and to make recommendations that are useful for conducting post-marketing database studies in Japan. We hope this article will become a help in the planning and implementation of future post-marketing database studies.