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BACKGROUND/OBJECTIVES: The level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders. SUBJECTS/METHODS: A cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey. RESULTS: The mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels. CONCLUSIONS: These results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.
Subject(s)
Adult , Female , Humans , Male , Asian People , C-Reactive Protein , Cholesterol , Cross-Sectional Studies , Energy Intake , Hypoalbuminemia , Inflammation , Japan , Lipoproteins , Motor Disorders , Nutrition Surveys , Nutritional Status , Platelet Count , Prevalence , Serum AlbuminABSTRACT
<p>Introduction: No formal curriculum has been formulated for teaching behavioral science to undergraduate medical students in Japan.<br>Method: We conducted a survey using the Delphi method to investigate the required competency in behavioral science for graduates in medicine. Then, we developed an outcome-oriented curriculum for teaching behavioral science.<br>Results: We propose an educational module of behavioral science consisting of 15 sessions of 90-minute lectures, small group discussions, and practice.<br>Discussion: We recommend including not only lectures but also practices according to problem-based learning as well as team-based learning in the curriculum to achieve the target outcome.</p>
ABSTRACT
In enabling consumers to make thetr own judgments regarding the risks of drugs, it is essntial to share information regarding the risks of drugs among stakeholders (governmental agencies, pharmaceutical companies, healthcare professionals and consumers or patients) and to have communication (risk communication).In particular, the communication between governmental agencies and consumers or patients is given a high priority. Hence, its provisions and strategies should be considered thoroughly.<br>FDA's risk communication efforts are part of a larger drug safety initiative that began in November 2004. In fact, FDA is engaged in verification and strategies aiming at strengthening drug safety. As a part of these efforts, FDA has published the "Guidance Drug Safety Information-FDA's Communication to the Public" and "FDA Strategic Plan for Risk Communication".<br>In this article, we present the "FDA Strategic Plan for Risk Communication" translated into Japanese and explain the situation of risk communication for drugs from the FDA perspective. We also examine the future of risk communication in Japan.
ABSTRACT
The promotion of clinical research in Japan requires the establishment of a formal and systematic education and training program for clinicians to ensure they become effective clinician investigators. The first of its kind in Japan, a formal 1-year masters-degree-level training program (MCR course) was started at Kyoto University School of Medicine and Public Health. The first 28 students graduated in 2008, with most returning to their original clinical institutions. <br>1) As follow-up, we conducted a self-administered questionnaire survey of all 28 graduates (response rate, 86%) concerning the current status of clinical research and problems encountered at their institutions.<br>2) Almost 40% of respondents (n=24) reported "no time" or "no research collaborators" for clinical research.<br>3) Twenty respondents (83%) have attempted to promote clinical research at their hospital or workplace, but only 1 has received institutional support.<br>4) Over half of the respondents (54%) would like to be working in both clinical research and clinical practice at their hospital in the future (10-year timescale). Forty-two percent of respondents had a concrete image of the clinical researcher's career path. <br>5) Although open to improvement, the MCR program presents a concrete model for the education of clinical researchers. These findings suggest that promoting the conduct of clinical research requires the implementation of a support system and adjustment of personal and physical infrastructure.
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EBM is the integration of best research evidence with clinical expertise and patient values. EBM has been extending to “evidence-based healthcare/practice” with wider perspectives. When considering healthcare-related evidence, it is useful to distinguish three aspects. Namely, they are “create”, “communicate”and “utilize”. At first, “clinical questions” are generated in real clinical settings. To create clinical evidence, “clinical questions” need to be refined as “research questions”. Concerning the aspect of communication, there are lots of proposals and statements to improve the reporting of research findings. The Uniform Requirements for Manuscripts Submitted to Biomedical Journals proposed by the International Committee of Medical Journal Editors has been evolved since 1979 and has become the global standard for scientific authors and editors. Concerning the aspect of “utilize”, there are two problems, that is, overuse and underuse of evidence. The former is related with the problem of evidence-practice gap. Appropriate use of clinical practice guidelines are expected to reduce these gaps. The latter is linked with the confusion that evidence equals EBM. Evidence is merely evidence even if the level is high in scientific and general meaning. When clinicians make individual decisions, they are required to do them comprehensively balancing the three factors such as evidence, value and resource.
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From the standpoint of a physician, drug safety data include not only information on adverse effects, but also information required to perform drug therapy safely. Drug safety data required by physicians include pharmacological data, name of the drug, history and physical data of patients, and an electronic or paper-based prescribing system at the clinic. Although most physicians are generally interested in drug safety data, a focus is not placed on adverse effects, given that they represent only a minor fraction of what is required for clinical practice and prescribing drugs. Moreover, Japanese physicians, who are busy with daily clinical practice, cannot find the time to extract essential information from what is supplied or to manage, make use, and report adverse events.<Br>Many problems exist in the management of drug safety data, especially for adverse effects, including collection of data, database management, and feedback to physicians. In particular, current adverse effect reporting systems rely too heavily on physicians. In order to improve the sensitivity and management of drug safety data in Japan, it is expected that not only physicians but also pharmacists, paramedical staff, and patients will report drug safety data. One promising possibility is the establishment of a special division at all medical facilities that manages drug safety data. This concept is similar to that of the Governmental Consumer Agency (Shohisha-cho) launched in 2009. As an issue, drug safety traverses all of healthcare, so it may be necessary for the drug safety division to adopt not only specialists whose subspecialties are more focused, but also general physicians.
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BACKGROUND: The purpose of our study was to compare the characteristics of medical practitioners who prefer using the Internet as their information resource and those who prefer using printed materials.<BR>METHODS: From December 2002 to January 2003, a non-anonymous questionnaire was sent out by post to members of the Japanese Medical Association (JMA) and physicians working in hospitals. Contributing factors were examined by using logistic regression analysis.<BR>RESULTS: The response rates for the questionnaires were 18.7% (n=1868) for JMA physicians and 68.0% (n=5901) for hospital physicians. Factors associated with the preference for using the Internet were: ‘younger age’; ‘use of the Internet to solve clinical problems and uncertainties’; ‘use of personal computers at work’; and, ‘use of personal computers at home’.<BR>CONCLUSION: The results of this study show that, although some younger physicians prefer printed materials, providing medical information via the Internet is better suited for younger physicians who are making full use of computers. In contrast, older physicians prefer printed materials because they tend to be less familiar with using computers and may have limited accessibility to the Internet. Therefore, using both the Internet and printed materials to provide medical information is necessary to meet the needs of the larger physician population.
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Evidence-based approach to the development of clinical practice guidelines has attracted significant attention from medical groups as well as from the public. According to the U.S. Institute of Medicine, clinical practice guidelines are defined as the systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. However, the role and importance of clinical practice guidelines are not fully understood by stakeholders in Japan. This review aims to introduce real movements related with clinical practice guidelines in Japan, problems and future prospects of them.<br>
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BACKGROUND: physicians' awareness regarding evidence-based medicine (EBM), clinical practice guidelines, and clinical information resources were rarely examined in Japan. We need to know them prior to the initiation of the Medical Information Network Distribution Service (Minds) by the Japan Council for Quality Health Care (JCQHC) .<BR>METHODS: A total of 10, 000 directors/owners of private clinics (CDs: clinic physicians) affiliated with the Japan Medical Association (JMA) and 8682 physicians working for hospitals certified by the JCQHC (HDs: hospital physicians) were randomly selected and surveyed by a mailed questionnaire.<BR>RESULTS: The response rate to the questionnaire was 18.7% (n=1865) among CDs and 67.8% (n=5885) among HDs. The percentage of respondents who uses internet was 39.9% among CDs and 69.3% among HDs. The information resource most commonly used by all respondents was medical journals, followed by textbooks. The percentage of respondents who used medical literature database was 10.8% among CDs and 49.7% among HDs, respectively. Approximately 80% of all respondents approved implementing EBM in daily practice. Fifty percent of all respondents indicated to have used clinical practice guidelines, and 90% of all the guideline users replied that clinical practice guidelines are useful tools for clinical decision-making. Over half of HDs required to access to the abstracts of the literature cited in the guidelines.<BR>CONCLUSIONS: Many physicians who responded to the survey acknowledged that EBM will contribute to improving the quality of medical services. They are positive in using clinical practice guidelines that include a series of recommendations proposed by specialists in the relevant field (s) in accordance to the reviewed evidence.
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In Japan, a government-funded project to develop evidence-based guidelines for the treatment of rheumatoid arthritis started in 1999. Methodologists, including epidemiologists and medical librarians, were asked to participate in this project. Working as a team, the rheumatologists, clinical epidemiologists, and medical librarians reviewed the published evidence systematically. The process and the results, particularly systematic search and review of literature, were assessed from the viewpoint of epidemiology and evidence-based medicine (EBM) . The librarians, supervised by the clinical epidemiologists, searched the literature according to 30 key questions defined by the rheumatologists and classified the articles according to the“level of evidence”. Finally, 379 articles were selected (drug therapy, 207; surgical treatment, 108; rehabilitation/devices, 64) . Meta-analyses and randomized controlled trials accounted for more than 80% of the drug treatment and rehabilitation/device reports, while nearly 70% of the articles retrieved regarding surgical treatment were case series without relevant control groups. The rheumatologists wrote structured abstracts for each article so that they could be used as reference for developing practice guidelines. The literature search, individual original articles, and the PubMed system were examined from the viewpoint of research methodology; the lessons learned were described.<BR>In conclusions, clinical epidemiologists and medical librarians have contributed to developing evidence-based practice guidelines. Clinical epidemiologists were able to work as a coordinator between clinicians and medical librarians. The popularity of EBM requires that expertise in this field be strengthened and made available to a broader audience.
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BACKGROUND: Although structured abstracts are becoming common in English-language journals, little is known about papers written in languages other than English.<BR>METHODS: To identify the percentages of reports of clinical trials with structured abstracts that are written in languages other than English, we used the PubMed to retrieve clinical trial reports written in seven languages other than English from 1987 to 2001.<BR>RESULTS: A total of 23, 075 reports of clinical trials written in seven languages other than English were identified. Of the 18, 278 reports that included abstracts, the share of structured abstracts in each language was as follows (entire period and 1999-2001 in parenthesis) : German, 17.3% (48.2%) ; French, 16.1% (45.1%) ; Italian, 21.3% (76.3%) ; Spanish, 44.7% (74.9%) ; Russian, 4.9% (17.4%) ; Chinese, 21.3% (100%), and Japanese, 3.5% (10.4%) .<BR>CONCLUSIONS: This study revealed that structured abstracts written in languages other than English have become popular, particularly since the late 1990s. However, the percentages of reports that include structured abstracts differ greatly among these languages.
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This study examined the effectiveness of a communication program in undergraduate medical education in improving communication in physicians' clinical practice. The effectiveness of the program was assessed with a mail survey using self-rated questionnaires 9 years later. Ninety participants were follwed up in late 1994; 57.8% of them replied to the questionnaire. Of the respondents, 60% replied that programs concerned with active listening and role-playing had benefits on communicating with patients and families. In addition, 40% of respondents answered that case studies aimed at teaching comprehensive medicine with the team approach was effective in improving communication with co-medical staff. These results suggest that the communication program in undergraduate medical education is effective in improving clinical communication in clinical practice when students are highly motivated.