Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years:n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V:n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.

Objective: To clarify whether early mobilization is a predictive factor for ambulation recovery in elderly patients and/or patients with severe subarachnoid hemorrhage (SAH).Methods: This multicenter retrospective observational study included 471 patients with treated SAH (Group 1). We focused on SAH patients with a poor prognosis, including a subgroup of elderly SAH patients (age>65 years: n=203) (Group 2) and patients with severe SAH (World Federation of Neurological Societies [WFNS] grade IV or V: n=117) (Group 3). The chi-square test and Mann-Whitney U test were used to compare the differences between the ambulation recovery group and the non-recovery group. Multivariable logistic regression analysis modeling was used to estimate odds ratios and 95% confidence intervals of early mobilization for the ambulation-recovered group within 30 days of onset compared with the unrecovered group. Other covariates examined as possible confounders of the outcome were age, sex, location of the ruptured aneurysm, modified Fisher scale score, WFNS grade, mode of treatment (surgical vs. endovascular), duration of cerebrospinal fluid drainage, days on mechanical ventilation, intracerebral hemorrhage, symptomatic cerebral vasospasm, complications, shunt placement for hydrocephalus, and time to start mobilization.Results: Early mobilization was an independent predictive factor for gait recovery in all groups. Furthermore, location of the ruptured aneurysm (anterior circulation), absence of complications, and absence of shunt placement were independent factors for ambulation recovery in all groups.Conclusion: Early mobilization in elder or/and sever patients with SAH may be a predictive factor for ambulation recovery within 30 days of onset.

We began providing comprehensive cardiac rehabilitation for congestive heart failure (CHF) in 2014 at our institution, using an original pamphlet and heart failure notebook to provide life guidance for CHF. However, the life guidance rate was lower in 2017 (61%) than it was in 2014 (77%). The objective of this study was to investigate the awareness of life guidance among nurses. We administered a questionnaire survey regarding life guidance to 28 nurses in December 2018. Among the 27 respondents, 26 nurses (96%) had high motivation and 21 (80%) felt a sense of accomplishment. Responses to the “most important point in life guidance” were “understanding living condition” by 14 nurses, “heart failure notebook” by 9 nurses, and “guidance using the pamphlet” by 6 nurses. Fifteen nurses (58%) felt that the guidance had become routine in nature, and 5 nurses (19%) were worried about their instruction. The nurses were motivated to provide life guidance, but they also felt that the guidance had become routine because they had been providing the same guidance for many years. We consider that the factors related to the lower life guidance rate are the routine/repetitive nature of the guidance and concerns about instruction. Going forward, we need to review the content of the guidance and the teaching approach.

Background: With the expanding use of social media, medical students have been posting an increasing amount of content that against ethics and professionalism.　Objective: To develop a checklist for social media use within medical education based on our national survey.　Methods: We analyzed and classified unprofessional behaviors that occurred over the past ten years in Japan. Then, we developed an event-based checklist for the use of social media use.　Result: The behaviors violating ethics and professionalism were classified into 3 categories. We have developed a social media checklist consisting of 10 items.　Discussion: Since social networking services are becoming vital information technology, every medical student or professional may risk unprofessional behaviors when they post or exchange any professional information. We propose appropriate education using an event-based checklist for social media usage.

Introduction: To implement effective medical education, it is important to clarify the process of recognizing and comprehending medical terms.　Methods: We conducted a questionnaire survey of 492 first- to fifth-year medical students to evaluate the recognition and comprehension rates of 57 medical terms in each grade. The terms were classified using the hierarchical cluster analysis based on the recognition and comprehension rates.　Results: The response rate was 91.1% (n=448). The 57 terms were classified into the following five clusters: #1, 30 terms that the students recognized and comprehended from Y1; #2, 18 terms that the students recognized from Y1 and comprehended as the grade increased; #3, six terms that the students recognized and comprehended as the grade increased; #4, two terms that the students recognized from Y1 but had not comprehended even in upper grades; #5, one term that the students recognized as the grade increased but had not comprehended even in Y5.　Discussion: Teachers may need to devise educational strategies while considering different patterns of students’ recognition and comprehension of medical terms.

The purpose of the present study was to examine characteristics of muscle anatomical cross-sectional area (CSA) for different regions from proximal to distal parts of each muscle of the hamstring muscles in high-level sprinters, and to examine the relationship with those and the sprint performance. The CSA of the semitendinosus (ST), semimembranosus (SM), biceps femoris long head (BFL) and biceps femoris short head (BFS) at the four different region of hamstring muscles for twenty sprinters (SPRINT) and twenty healthy male control subjects (CTRL) were measured by using B-mode ultrasonography. The measured regions were divided into four parts from proximal to distal parts (PRO1, PRO2, DIS2, DIS1). The results clearly showed that absolute CSA values in distal parts for all muscles together with PRO2 in ST were greater in SPRINT than in CTRL. When relative CSA values to the entire hamstrings muscles in each region were compared, only relative CSA at PRO1 in ST was greater in SPRINT than in CTRL, conversely, that at proximal regions in BFL and distal regions in BFS were smaller in SPRINT. In the relationships with sprint performance, the CSAs at PRO1 and PRO2 in ST and at PRO1 in SM were only related negatively. These results suggest that distal parts of hamstring muscles for SPRINT may be characteristics for sprint runners. However, the movements related to the specific hypertrophy (PRO1 and PRO2 in ST, PRO1in SM) may play important roles of the improvement of their sprint performance.

　　With a view to preventing surgical site infection (SSI), administration of antimicrobial agents during surgery should be performed every 3-4 hours after the first administration before surgery begins. In our hospital, the infection control team (ICT) tried to intervene with surgeons and all operating room staff to improve compliance with the administration of antimicrobial agents. The purpose of this study was to evaluate the impact of this intervention by the ICT on correct administration of antimicrobial agents during surgery. In total, 435 surgeries which included ≥ 210 min under anesthesia or 180 min of the operation were analyzed. All antimicrobial agents were first administered within 60 min before the start of surgery. At some point, the ICT intervened, recommending that antimicrobials be administered every 3 h during surgery. The compliance rate (CR) of surgeries for the correct administration of antimicrobial agents was investigated. Differences in CR were evaluated (1) among departments (gastroenterology and general medicine [GM], orthopedic surgery [OR], otorhinolaryngology [OL], gynecology [GY], and urology [UR]), (2) whether intervention of ICT was carried out or not, and (3) in terms of specific procedures (endoscopy and laparoscopy). Total CR was 51.0% (GM: 67.0%, OR: 27.1%, OL: 40.5%, GY: 45.5%, and UR: 37.5%). CR was significantly higher in GM than in any other departments. CR with and without intervention was 69.9% and 42.7%, respectively, and this was statistically significant. CR in endoscopy was 25.8%, which was significantly lower than that in other surgeries (55.2%). CR in laparoscopy was 63.1%, which was significantly higher than that in other surgeries (47.3%). Intervention by the ICT resulted in significant improvement of CR for correct administration of antimicrobial agents. However, CR was low in some situations. This could be improved by more careful dialogue with surgeons and operating room staff.

The purpose of the present study was to examine the importance of the agonist muscle activity of the post-impact 30 ms phase during drop jump (DJ) for effective rebound performance by comparing those of sprint runners and swimmers. The eight sprint runners (SPRINT) and twelve swimmers (SWIM) were participated in this study. They performed DJ from a 0.3-m height box with maximal rebound efforts. Electromyograms (EMG) of the lower leg muscles (medial gastrocnemius [MG], soleus [SOL] and tibialis anterior [TA]), and vertical ground reaction force together with kinematic data were measured simultaneously during DJ. In addition, the onsets of fascicle stretching of the MG and SOL muscles were measured by using high-speed ultrasonography (521Hz) during DJ. The onsets of the fascicle stretching of SOL during DJ were not significantly different between SPRINT and SWIM (15 ± 7 ms and 16 ± 6 ms, respectively). During DJ, SPRINT showed onset of the SOL EMG before the ground contact (-26 ± 19 ms). Meanwhile, SWIM showed the onset of the SOL EMG after the ground contact of DJ (16 ± 19 ms). These results suggest that the SOL muscles for SWIM cannot be fully-activated during the braking phase. Consequently, the rate of force development during the braking phase of DJ and subsequently rebound height could be reduced in SWIM.

　To encourage the broad use of simulation-based medical education and establish partnerships to promote objective structured clinical examinations after clinical clerkship among medical teachers, we hosted the first team-based clinical skills competition event for medical students in Japan, named ‘Medical Students' Simlympic Games 2014'. Thirty-six (12 teams of three) open-recruited 5th or 6th grade medical students participated in this event. Student teams performed clinical tasks at 6 stations, which actively utilized the strengths of simulators or simulated patients. Contents, composition, difficulty level, and validity were tested by trainee doctors and examined by committee members in advance. In this report, we describe our concept, executive committee formation, a variety of arrangements, the outline on the day of the event, and the results of a questionnaire targeting participants. (126 words)