Since 2005, one of our clinical technologists has been involved in providing assisted reproductive technology (ART) services ranging from egg retrieval to embryo transfer, which were previously performed only by doctors at our hospital. In 2011, the clinical technologist was certified as a clinical embryologist by the Japanese Society of Clinical Embryologists. Around 2020, insurance coverage for ART related to infertility treatment began to be considered. Consequently, the training and development of ART-supporting clinical technologists became an urgent issue. In response, we developed a training program for ART-supporting clinical technologists that covers egg retrieval assistance, fertilization, culture, embryo freezing/thawing, and embryo transfer. By the end of fiscal year 2022, we had successfully trained two new ARTsupporting clinical technologists, bringing the total to three.

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease causing dyspnea on exertion, exercise intolerance, decline in quality of life, and physical inactivity. The patient is a 78-year-old male. He complained of quadriplegia and was diagnosed with a C7/Th1 cervical epidural abscess. After treatment with antibiotics, he was transferred to our hospital. He had tetraplegia, which corresponded to the ASIA impairment scale D, and his Functional Independence Measure (FIM) motor score was 35 points. In addition, he had severe COPD; the Medical Research Council (MRC) dyspnea scale was grade 5, and the COPD assessment test (CAT) score was 26 points. He complained of dyspnea on exertion with low intensity movements. Despite rehabilitation, improvement in ADL and physical function was poor, his FIM motor score was 43 points and the Berg balance scale (BBS) score was 21 points at the 30th day. Therefore, we started assist use of a short-acting β2 agonist (SABA) before rehabilitation on the 33rd day, and his dyspnea on exertion, physical activity, and respiratory dysfunction improved. On the 83rd day, the improvement was as follows: the MRC dyspnea scale was grade 4, the CAT score was 18 points, his 6-minute walk distance was 110 m, and his BBS score was 40 points. He was weaned from continuous oxygen therapy and discharged on day 112, at which time his FIM motor score was 69 points. We considered that the assist use of SABA before rehabilitation improved his respiratory status and physical activity without worsening his respiratory function or limb muscle weakness due to dyspnea and quadriplegia.

Objective: Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis.Patient: An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test.Results: Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions.Conclusion: Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.

Objective: The purposes of this trial were to demonstrate the feasibility and effectiveness of the hybrid of intracavitary and interstitial brachytherapy (HBT) for locally advanced cervical cancer patients in the phase I/II prospective clinical trial. Methods: Patients with FIGO stage IB2-IVA uterine cervical cancer pretreatment width of which was ≥5 cm measured by magnetic resonance imaging were eligible for this clinical trial. The protocol therapy included 30–30.6 Gy in 15–17 fractions of whole pelvic radiotherapy concurrent with weekly CDDP, followed by 24 Gy in 4 fractions of HBT and pelvic radiotherapy with a central shield up to 50–50.4 Gy in 25–28 fractions. The primary endpoint of phase II part was 2-year pelvic progression-free survival (PPFS) rate higher than historical control of 64%. Results: Between October 2015 and October 2019, 73 patients were enrolled in the initial registration and 52 patients proceeded to the secondary registration. With the median follow-up period of 37.3 months (range, 13.9–52.9 months), the 2- PPFS was 80.7% (90% confidence interval [CI]=69.7%–88%). Because the lower range of 90% CI of 2-year PPFS was 69.7%, which was higher than the historical control ICBT data of 64%, therefore, the primary endpoint of this study was met. Conclusion The effectiveness of HBT were demonstrated by a prospective clinical study. Because the dose goal determined in the protocol was lower than 85 Gy, there is room in improvement for local control. A higher dose might have been needed for tumors with poor responses.

To improve resident performance in clinical practice, the R2C2 model was developed for supervisors who need to guide their residents’ reflection. It consists of four stages: Relationship building, exploring Reactions, exploring Content, and Coaching. It has been shown to effectively engage residents in reflective, goal-oriented discussions and in developing a Learning Change Plan with their supervisors. This paper introduces the Japanese translated version of the model and the evidence of its use.

BACKGROUND: Despite the importance of hepatitis screening for decreasing liver cancer mortality, screening rates remain low in Japan. Previous studies show that full subsidies increase screening uptake, but full subsidies are costly and difficult to implement in low-resource settings. Alternatively, applying nudge theory to the message design could increase screening at lower costs. This study examined the effects of both methods in increasing hepatitis virus screening rates at worksites. METHODS: 1496 employees from a Japanese transportation company received client reminders for an optional hepatitis virus screening before their general health checkups. Groups A and B received a client reminder designed based on the principles of "Easy" and "Attractive," while the control group received a client reminder not developed using nudge theory. Additionally, hepatitis virus screening was offered to the control group and group A for a co-payment of JPY 612, but was fully subsidized for group B. The hepatitis virus screening rates among the groups were compared using a Chi-square test with Bonferroni correction, and the risk ratios of group A and group B to the control group were also calculated. To adjust for unobservable heterogeneity per cluster, the regression analysis was performed using generalized linear mixed models. RESULTS: The screening rate was 21.2%, 37.1%, and 86.3% for the control group, group A, and group B, respectively. And the risk ratio for group A was 1.75 (95% confidence interval [CI] 1.45-2.12) and that of group B was 4.08 (95% CI 3.44-4.83). The parameters of group A and group B also were significant when estimated using generalized linear mixed models. However, the cost-effectiveness (incremental cost-effectiveness ratio (ICER)) of the nudge-based reminder with the full subsidies was lower than that of only the nudge-based reminder. CONCLUSIONS While fully subsidized screening led to the highest hepatitis screening rates, modifying client reminders using nudge theory significantly increased hepatitis screening uptake at lower costs per person.
Adult ; Aged ; Aged, 80 and over ; Cost-Benefit Analysis ; Female ; Hepatitis Viruses/isolation & purification* ; Humans ; Japan ; Male ; Mass Screening/instrumentation* ; Middle Aged ; Workplace

This paper outlines the essentials that each organizer of Faculty and Staff Development (FSD) programs in Health Professions Education should focus on when designing a program. The essentials are as follows: the reasons for studying at FDS, the place of practice, content, participants, peers, location, methods, timing, and evidence of learning. These will also help FSD participants think about their perspectives when they choose to participate in the program. It is hoped that more people will get involved in Health Professions Education to increase their knowledge and spice up their daily teaching practice. It is also hoped that those who complete the course will become Faculty Developers in their own areas and professions, revitalizing health professions education and cooperatively increasing the presence of Japanese Health Professions Education.

Purpose: Not enough attention has been paid to defecation habits in Japan. This study aimed to emphasize the importance of defecation habits on health and function in Japanese pupils. Methods: Using multiple regression analysis, 2,722 questionnaires obtained from pupils in grades 5 to 12 were analyzed to determine lifestyle habits associated with defecation frequency. Results: Significant regression formulae for defecation scores were obtained for all school types: elementary school (ES) (adjusted R2 =0.08, p<0.001), junior high school (JHS) (0.09, p<0.001), and senior high school (SHS) (0.15, p<0.001). The following factors were associated with poorer defecation scores, according to school type: female gender (all 3 school types), breakfast skipping (elementary and JHSs), lower physical activity (JHSs and SHSs), and longer school-day screen time (elementary and SHSs). In addition, poorer selfreported academic performance scores in ES, less standardized body mass index (BMI) in JHS, and shorter non-school- day screen time scores in SHS, were associated with poorer defecation scores. Conclusion Poor defecation frequency showed significant associations with various lifestyle habits, such as breakfast skipping, physical activity, and screen time, among pupils. Academic performance and standardized BMI were also associated with defecation frequency. More attention should be paid to defecation frequency to sustain health and function in pupils.

 Hot sprigs elements and balneological effects of Tokyo 23 wards, which is not recognized as hot spring region were considered. The density of the hot spring’s source in this region is high compared to other parts of the country. Moreover, a useful element and temperature for the balneological treatment was confirmed by the hot springs with deep digging in a lot of places.  The hot springs in Tokyo can be classified into the NaCl strong salt hot springs, NaHCO3, and the sodium metasilicates. The strong Na-Cl (salt) springs are recognized in hot springs found by deep digging, and exists everywhere in Tokyo. The hot springs of the NaHCO3 are localized in Ohta ward by moderate depth digging. The hot springs including with the rich sodium metasilicates in Ohta ward by shallow digging. If the hot springs in Tokyo are to be used the balneologically, the following effects are expected.  Thermal and warm keeping effects can be expected from the strong Na-Cl (salt) springs. Cleanness and smoothing effects of the skin can be expected of NaHCO3. Hyperkeratosis of the skin can be expected from rich sodium metasilicates.

The present study was designed to examine the positive impact of collagen and glucosamine hydrate supplementation on joint markers, matrix metalloproteinase-3 (MMP-3), tissue inhibitor of metalloproteinases-1 (TIMP-1) and keratane sulfate (KS) . Thirteen healthy fun-runners supplemented collagen and glucosamine hydrate for 30 days. Blood samples were collected on days 0, 15 and 30. The test-drink supplement, however, significantly decreased MMP-3 and KS on days 15 and 30. These results suggest that the supplementation of collagen and glucosamine hydrate may prevent injury and inflammation of joint cartilages and be useful for joint conditions.