Background: and Purpose Differences in measurement of the extent of acute ischemic stroke using the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) by non-contrast computed tomography (CT-ASPECTS stratum) and diffusion-weighted imaging (DWI-ASPECTS stratum) may impact the efficacy of endovascular therapy (EVT) in patients with a large ischemic core. Methods: The RESCUE-Japan LIMIT (Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism Japan–Large IscheMIc core Trial) was a multicenter, open-label, randomized clinical trial that evaluated the efficacy and safety of EVT in patients with ASPECTS of 3–5. CT-ASPECTS was prioritized when both CT-ASPECTS and DWI-ASPECTS were measured. The effects of EVT on the modified Rankin Scale (mRS) score at 90 days were assessed separately for each stratum. Results: Among 183 patients, 112 (EVT group, 53; No-EVT group, 59) were in the CT-ASPECTS stratum and 71 (EVT group, 40; No-EVT group, 31) in the DWI-ASPECTS stratum. The common odds ratio (OR) (95% confidence interval) of the EVT group for one scale shift of the mRS score toward 0 was 1.29 (0.65–2.54) compared to the No-EVT group in CT-ASPECTS stratum, and 6.15 (2.46–16.3) in DWI-ASPECTS stratum with significant interaction between treatment assignment and mode of imaging study (P=0.002). There were significant interactions in the improvement of the National Institutes of Health Stroke Scale score at 48 hours (CT-ASPECTS stratum: OR, 1.95; DWIASPECTS stratum: OR, 14.5; interaction P=0.035) and mortality at 90 days (CT-ASPECTS stratum: OR, 2.07; DWI-ASPECTS stratum: OR, 0.23; interaction P=0.008). Conclusion Patients with ASPECTS of 3–5 on MRI benefitted more from EVT than those with ASPECTS of 3–5 on CT.

To ensure public trust in health professions, it is imperative for health professionals to understand the concept of conflict of interest (COI) in health professions education and manage it appropriately. However, there are not enough formal curricula on COI in health professions education in Japan. We propose an educational curriculum on COI in health professions education which focuses on relationship between physicians and for-profit corporations. We hope that this proposed curriculum stimulates educational activities on the ground while taking context into account. We also hope the proposed curriculum leads to the formal incorporation of COI in health professions education and educational policies nationwide.

Objective : Risk factors for SSI after open heart surgeries were evaluated in relation to a bundle of SSI preventive measures. Methods : Research design is a retrospective cohort study. The study population was 1,579 patients who had received open heart surgeries at Kobe City Medical Center General Hospital from January 2008 to December 2010 (Period I : when standard infection prevention measures were implemented) and from January 2014 to December 2016 (Period II : after a relocation of the hospital to a new campus and enhanced infection prevention measures were implemented). Factors associated with SSI were determined using univariate modelling analysis followed by multi-variate logistic regression analysis. The Center for Disease Control and Prevention definition of SSI was used for case determination. Results : Overall SSI incidence was 4.5%. SSI incidence decreased significantly from 6.6% in Period I to 2.9% in Period II (p＜0.001). Significant improvement in adherence to the recommended preventive measures was observed in Period II in selection of appropriate antibiotics, discontinuation of prophylactic antibiotics within 72 h after surgery and glucose control on post-operative Day 1 and 2 (p＜0.001). A univariate analysis showed statistical significance in surgical procedure, surgical period, surgical duration, post-operative day 2 morning glucose level, administration of prophylactic antibiotics within 1 h before incision, 100% compliance with the Bundle. Complex surgery (odds ratio 2.5 ; 95%CI 1.3～4.8) were identified as a risk factor by multiple logistic regression. Surgical period (Period II, odds ratio 0.41 ; 95%CI 0.28～30.71) and administration of prophylactic antibiotics within 1 h before incision (odds ratio 0.57 ; 95%CI 0.33～0.97) reduced SSI risks. Conclusion : The study demonstrated administration of prophylactic antibiotics within 1 h before incision was particularly important for SSI prevention. Higher compliance with SSI bundle and a special attention to patients receiving complex surgery were also warranted.

The use of clinical databases is becoming increasingly common. We introduce a real-time clinical database named SINAP (Stroke Improvement National Audit Programme) which was originally deployed as a research database. We addressed its educational application in a hospital.
We visited a leading stroke ward in the UK, which had a hyper acute stroke facility, and investigated the current operation and application of the SINAP database. The ward contained a hyper acute stroke unit with 12 beds and a 20-bed stroke unit. About 400 patients were treated in three months (January-March, 2011). The SINAP database was used not only for research reports but also for conferences concerning patient management, and it facilitated learning by clinical staff at the hospital.
Databases which record clinical data relevant to performance and quality are an effective tool for improving the quality of treatment and care, as well as for training staff in clinical practice. Considering the wide-spread use of information technologies in primary care, such utilization of clinical data seems appropriate and effective to improve the quality of practice.

Objective:It is well known that the use of benzodiazepines is associated with falling in elderly people, but there have been few researches focused on changes in the dose of benzodiazepines and falls. If the association between changes in the dose of benzodiazepines and falling becomes clear, we may take an action to prevent falling.In this study, we investigated the association between changes in the dose of benzodiazepines and falling among elderly inpatients in an acute-care hospital.
Design:Falling generally results from an interaction of multiple and diverse risk factors and situations, and medication history of each subject must be considered in this study. We conducted a case-crossover study in which a case was used as his/her own control at different time periods. Therefore covariates that were not time-dependent were automatically adjusted in this study.
Methods:Subjects were patients who had falling at one hospital between April 1, 2008 and November 30, 2009. Data were collected from incident report forms and medical records. Odds ratio for changes in the dose of benzodiazepines were calculated using conditional logistic regression analyses.
Results:A total of 422 falling by elderly people were eligible for this study. The odds ratio for increased amounts of benzodiazepines was 2.02(95% Confidence Interval(CI):1.15, 3.56). On the other hand, the odds ratio for decreased amounts of benzodiazepines was 1.11(95%CI:0.63,1.97).
Conclusion:There was an association between increased amounts of benzodiazepines and falling. Hence, it is considered meaningful to pay attention to falling when amounts of benzodiazepines are increased to prevent falling in hospitals.

BACKGROUND : Norm-referenced equations to predict the 6-minute walk distance (6MWD) in healthy Japanese subjects have not been established. The current study aimed to determine the reference values for 6MWD in healthy Japanese adults.
METHODS : Ninety-seven healthy Japanese men and women aged 40-79 years were recruited from Kyoto city using posters and flyers. Measurements of 6MWD were performed twice on an indoor 30 m track with 20 minutes rest between the two tests. Before performing the tests, age, gender, height, body weight, waist circumference, a questionnaire for health status, spirometry, and a 12-lead electrocardiogram were recorded. The 6MWD was measured following guidelines published in 2002 by the American Thoracic Society.
RESULTS : The mean age of the study subjects was 57.0±9.4, and 63 of the 97 subjects were female. The mean 6MWD for all subjects was 672±83 m, with a range of 483-903 m. The 6MWD is significantly correlated with age, height, waist circumference, forced vital capacity (FVC), and forced expiratory volume in one second (FEV₁). A multiple linear model showed age, waist circumference, and FVC were significantly associated with 6MWD and the model explained 35% of the variability in 6MWD. When FVC was replaced by height, the regression model also explained 32% of the variation. The measured 6MWD of Japanese subjects was similar to the predicted 6MWD using the equations derived from Caucasian subjects.
CONCLUSIONS : The 6MWD was affected to a substantial degree by age, waist circumference, height, and FVC in healthy Japanese adults.

1) We conducted a randomized controlled trial in medical education area and explored practical issues through reflection on the processes.
2) In February 2007, 39 fourth-year medical students in Nippon Medical School listened to the lecture about how to ask key questions for the diagnosis. Shortly after they had medical interview with a standardized patient for measurement purpose. They were randomly allocated to study and control groups. The lecture content for the intervention group corresponded to the interview but the one for the control group did not correspond to the interview.
3) We identified the issues related with ethical review for research, how to mask the information of randomization out of assessors, and equity of educational intervention and assessment offered to both groups.