Foreign Patients Visiting the Emergency Department: A Systematic Review of Studies in Japan.

Background: As the number of non-native patients in Japan is increasing, emergency departments must provide proper care for international patients. However, no research has been conducted to determine the demographics of international patients that visit Japanese hospitals or the requirements to accept them. We aimed to organize the existing research and its patterns for foreign patients in Japan's emergency departments and to identify the areas that require further research. Methods: Systematic review of research articles indexed in MEDLINE and Ichushi-web (Japanese medical literature) was conducted. The search strategy was based on a previous study in Japanese, and the search was limited to manuscripts published from 2015. Results: Nine publications that reported on the demographic characteristics of foreign patients who visited the emergency department were among the study's 13 references. Injury diagnoses and the Asian population were both common. Dealing with overseas patients can be challenging due to linguistic barriers, cultural differences, and payment issues. However, studies describing the spoken language and the type of healthcare insurance used were lacking. Furthermore, neither the definition of "foreign patients" nor the distinction between short-term visitors and long-term residents were made in the majority of the research. Conclusions: The demographic characteristics of patients differed depending on the location and facility, despite the fact that several characteristics of foreign patients in emergency departments appeared to be generalizable. The COVID-19 pandemic may modify the demographic characteristics of immigrants; thus, more research from a broad range of locations and medical facilities is still necessary.

Medical Education during the COVID-19: A Review of Guidelines and Policies Adapted during the 2020 Pandemic.

The novel coronavirus disease (COVID-19) pandemic has dramatically changed education systems as most governments around the world closed schools to prevent outbreaks on campus. Medical education was not immune from these policies, and medical students were deprived of opportunities, particularly in clinical training. To determine how countries worldwide have responded to the pandemic, we conducted a literature review of the policies and guidelines of four countries: Japan, the United States (USA), the United Kingdom (UK) and Australia, as well as case reports of faculty and medical students up to September, 2020. Although the methods of implementation were unique to each country, the concept of "returning medical students to live education as quickly and safely as possible" was common. However, the extent to which students and faculty members became engaged in the treatment process of COVID-19 varied. While some countries endorsed students to work as members of medical staff to treat COVID-19, other countries took measures to ensure the safety of both medical students and patients. We await further reports worldwide in order to better understand the strategies employed by different nations in preparation for future possible infection outbreaks.

Encouraging Students and Trainees to Write.

Publications from Japan have been on the decline, and this tendency is expected to continue as the country's population decreases. During the novel coronavirus disease (COVID-19) pandemic, it was discovered that Japanese medical trainees published much fewer papers than trainees from other nations. This issue must be addressed by the entire Japanese medical community. Trainees have the potential to contribute to the medical community through their publishing process presenting fresh perspectives and communicating accurate information to the public through the use of social media. Furthermore, trainees themselves would benefit as they would become more enhanced by deeply and critically considering the contents and the trends of publications worldwide, which would promote further implementation of evidence-based medicine. Therefore, medical educators and students should be motivated and encouraged to write by offering enough instructional and publication opportunities. Such measures would be to (1) train students in "medical writing" as part of the medical curriculum; (2) encourage medical students and trainees to submit of manuscripts, especially in the section of the letters, opinions, and case reports; (3) guarantee trainees time and resources to write; (4) provide as constructive reviews and comments as possible as an educational opportunity for trainees; and (5) motivate trainees to write. Such hands-on training would necessitate significant efforts of the trainees, instructors, and publishers. However, if we cannot invest in fostering future resources now, we may not be able to hope for increase in the amount of research published from Japan. The future lies in everybody's hands.

Utilizing Graphical Analysis of Chest Radiographs for Primary Screening of Osteoporosis.

Background and Objectives: Osteoporosis is a major risk of fractures, harming patients' quality of life. Dual-energy X-ray absorptiometry (DXA), which can detect osteoporosis early, is too expensive to be conducted on a regular basis. Therefore, we aimed to evaluate a screening method using chest radiographs developed in Japan applied to another population. Materials and Methods: Fifty-five patients who had a chest radiograph and DXA and applied within three months of each test were recruited from the patient database of Semmelweis University (Budapest, Hungary). Graphical analysis of the chest radiographs was conducted to identify the ratio of the cortical bone in the clavicle of each patient. Two researchers performed the analysis, and multiple regression was conducted to determine the bone mineral density of each patient provided by DXA. Results: The Pearson correlation between two examiners' determinations of the cortical bone ratio was 0.769 (p < 0.001). The multiple regression model proved to be statistically significant in identifying osteoporosis, but the model adopted for the Hungarian population was different compared to the Japanese population. Conclusions: This simple, economic Japanese graphical analysis method for chest radiographs may be feasible in detecting osteoporosis. Further studies with a larger population of patients with greater variety of ethnicity would be of value in improving the accuracy of this model.

Preventing the Worst, Recovering with Resilience.

On July 8, 2022, Shinzo Abe, the former Prime Minister of Japan, passed away. This tragedy may turn out to have a deep impact on public health throughout the world, not limited to Japan. According to the most recent Japanese government reports, Mr. Abe was murdered with a firearm. This could spark a new debate in the current global debate over gun control, with far-reaching consequences for public health around the world. Furthermore, extensive media coverage may harm the mental health of Japanese civilians, and such issues should be addressed in a fair manner. The Japanese have been strong against previous disasters and tragedies. It is hoped that Japan can build back a safe and resilient society for all.

An International Aircraft Transport of a Neonate From Georgia to Japan.

International air transport over long distances necessitates considerable effort. It is even more challenging when the patient is a neonate and has a congenital disease. We hereby report a case of an international aircraft transport of a neonate from Tbilisi, Georgia to Osaka, Japan. The patient was transported to Osaka University Hospital after being diagnosed with a double outlet right ventricle (DORV), requiring surgical intervention. This unique experience has raised four issues: 1) language issues for referral and consultation; 2) medical equipment and healthcare professionals required to accompany the transport for adequate care; 3) scheduling of the international flight; and 4) the administrative procedures such as birth certificate, passport, and healthcare insurance. In this report, we describe how the patient was successfully transported, received treatment, and discharged home.

Lobular Difference in Heritability of Brain Atrophy among Elderly Japanese: A Twin Study.

Background and Objectives: Brain atrophy is related to cognitive decline. However, the heritability of brain atrophy has not been fully investigated in the Eastern Asian population. Materials and Methods: Brain imaging of 74 Japanese twins registered in the Osaka University Twin Registry was conducted with voxel-based morphometry SPM12 and was processed by individual voxel-based morphometry adjusting covariates (iVAC) toolbox. The atrophy of the measured lobes was obtained by comparing the focal volume to the average of healthy subjects. Classical twin analysis was used to measure the heritability of its z-scores. Results: The heritability of brain atrophy ranged from 0.23 to 0.97, depending upon the lobes. When adjusted to age, high heritability was reported in the frontal, frontal-temporal, and parietal lobes, but the heritability in other lobes was lower than 0.70. Conclusions: This study revealed a relatively lower heritability in brain atrophy compared to other ethnicities. This result suggests a significant environmental impact on the susceptibility of brain atrophy the Japanese. Therefore, environmental factors may have more influence on the Japanese than in other populations.

Foreign patients in emergency departments of Japanese medical facilities.

Our manuscript is a letter to the article "Factors associated with emergency department length of stay of foreign patients visiting a regional core hospital in Japan." by Aoki et al. published ahead of print in Acute Medicine and Surgery. We believe that the manuscript by Aoki et al. is the first publication to suggest that linguistics play an important role in the outcomes of foreign patients in Japanese medical facilities, and applaud them for their contribution. However, we also believe that further assessments are required to make their implications more robust. Therefore, in our manuscript, we would like to highlight several criteria that should be included in such studies, derived from studies that have been conducted under similar situations in Japanese medical facilities.

Challenges and the potential of promoting remote medical interpreting during COVID-19.

Language barriers negatively affect patient outcomes, and linguistic assistance is essential for adequate healthcare. The adoption of face-to-face medical interpretating is believed to have been rendered more challenging by the implementation of hospital admission restrictions following the outbreak of novel coronavirus disease (COVID-19). On the other hand, remote interpretating can be implemented using merely equipment, enabling it to be introduced without being impacted by the transmission of illness, and its use may have spread globally. To comprehend how COVID-19 has impacted remote interpreting utilization and what issues have arisen, we conducted a systematic review of two databases, PubMed and Ichushi-web (Japanese medical literature) with "remote interpreting" and "COVID-19" as keywords in June, 2022. Five references were included in the review. The research supported an increase in remote interpreting during COVID-19 to limit the risk of infection. This change in the trend of medical interpreting has the potential of promoting remote medical interpreting for places lacking sufficient linguistically skilled human resources, regardless of the pandemic status. There have also been accounts of novel methods of remote medical interpretation in which neither the healthcare professional nor the interpreter was face-to-face with the patient, and difficulty was acknowledged by both the healthcare professional and the patient with remote interpreting. To fully take advantage of the possibilities of remote interpreting, additional training and support would be required. Further studies are also required to determine the best way to employ this technology.