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1.
BMC Med Educ ; 21(1): 415, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344354

RESUMO

BACKGROUND: Patient care ownership (PCO) is an essential component in medical professionalism and is crucial for delivering high-quality care. The 15-item PCO Scale (PCOS) is a validated questionnaire for quantifying PCO in residents; however, no corresponding tool for assessing PCO in Japan exists. This study aimed to develop a Japanese version of the PCOS (J-PCOS) and validate it among Japanese medical trainees. METHODS: We performed a multicenter cross-sectional survey to test the validity and reliability of the J-PCOS. The study sample was trainees of postgraduate years 1-5 in Japan. The participants completed the J-PCOS questionnaire. Construct validity was assessed through exploratory and confirmatory factor analyses. Internal consistency reliability was examined by calculating Cronbach's alpha coefficients and inter-item correlations. RESULTS: During the survey period, 437 trainees at 48 hospitals completed the questionnaire. Exploratory factor analysis of the J-PCOS extracted four factors: assertiveness, sense of ownership, diligence, and being the "go-to" person. The second factor had not been identified in the original PCOS, which may be related to a unique cultural feature of Japan, namely, a historical code of personal conduct. Confirmatory factor analysis supported this four-factor model, revealing good model fit indices. The analysis results of Cronbach's alpha coefficients and inter-item correlations indicated adequate internal consistency reliability. CONCLUSIONS: We developed the J-PCOS and examined its validity and reliability. This tool can be used in studies on postgraduate medical education. Further studies should confirm its robustness and usefulness for improving PCO.


Assuntos
Propriedade , Tradução , Estudos Transversais , Humanos , Japão , Assistência ao Paciente , Psicometria , Reprodutibilidade dos Testes , Inquéritos e Questionários
2.
Arch Gerontol Geriatr ; 96: 104434, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34030044

RESUMO

BACKGROUND: Atrial fibrillation (AF) in patients aged ≥75 is one of the major risk factors for stroke, and prescription of oral anticoagulants (OACs) should be considered in these patients. We investigated the use of OAC' for patients certificated for long-term care (LTC) insurance, who have a high risk of bleeding among older patients. METHODS AND RESULTS: From 1169 consecutive inpatients aged 75 or older who were admitted to the geriatric ward of The University of Tokyo Hospital between 2012 and 2017, we identified 175 patients (men 48%, mean age 85.5 years) who had AF during admission. The patients' background, prescription of OACs on discharge, and the level of LTC insurance were checked. Patients were followed up for 1 to 5 years. Major bleeding, stroke, and all-cause mortality were investigated as outcomes. Among patients with AF, 63.4% were taking OACs. In multivariate analysis, older age, low BMI and no history of stroke were significant factors for not prescribing OACs. Care level patients with OACs had a higher incidence of stroke than others. There was no difference, irrespective of OAC prescription and disability level, in incidence of major bleeding. Care level patients without OACs had higher mortality than others. CONCLUSIONS: These results suggest that older care level patients with AF may benefit less from OACs.


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Humanos , Seguro de Assistência de Longo Prazo , Masculino , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle
5.
BMC Med Educ ; 21(1): 85, 2021 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-33531010

RESUMO

CONTEXT: The Japan Residency Matching Program (JRMP) launched in 2003 and is now a significant event for graduating medical students and postgraduate residency hospitals. The environment surrounding JRMP changed due to Japanese health policy, resulting in an increase in the number of unsuccessfully-matched students in the JRMP. Beyond policy issues, we suspected there were also common characteristics among the students who do not get a match with residency hospitals. METHODS: In total 237 out of 321 students at The University of Tokyo Faculty of Medicine graduates from 2018 to 2020 participated in the study. The students answered to the questionnaire and gave written consent for using their personal information including the JRMP placement, scores of the pre-clinical clerkship (CC) Objective Structured Clinical Examinations (OSCE), the Computer-Based Test (CBT), the National Board Examination (NBE), and domestic scores for this study. The collected data were statistically analyzed. RESULTS: The JRMP placements were correlated with some of the pre-CC OSCE factors/stations and/or total scores/global scores. Above all, the result of neurological examination station had most significant correlation between the JRMP placements. On the other hand, the CBT result had no correlation with the JRMP results. The CBT results had significant correlation between the NBE results. CONCLUSIONS: Our data suggest that the pre-clinical clerkship OSCE score and the CBT score, both undertaken before the clinical clerkship, predict important outcomes including the JRMP and the NBE. These results also suggest that the educational resources should be intensively put on those who did not make good scores in the pre-clinical clerkship OSCE and the CBT to avoid the failure in the JRMP and the NBE.


Assuntos
Estágio Clínico , Internato e Residência , Competência Clínica , Computadores , Avaliação Educacional , Humanos , Japão
6.
PLoS One ; 15(12): e0243242, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33270749

RESUMO

Metabolic syndrome (MetS) is an important predictor of mortality in older adulthood, but it is not reliably related to measures of body composition such as body mass index in older adults, as opposed to those in earlier life stages. Previous research suggests that skeletal muscle mass is related to cardiovascular risk in older adulthood, but it is difficult to measure muscle mass accurately and independently of body fat. This study aimed to examine the relationship between body composition and cardiovascular risk factors among women in older adulthood. A cross-sectional observational clinical study was conducted at a single medical clinic in Tokyo, Japan. Participants included 90 healthy Japanese women aged 65 years and older. MetS risk factors were assessed. Appendicular skeletal muscle mass (ASM) was assessed using dual-emission X-ray absorptiometry. Visceral fat area (VFA) was measured using computed tomography. VFA positively correlated with ASM and MetS, whereas ASM and MetS did not correlate with each other. Using VFA and ASM data in a MetS multiple linear regression model, the association between VFA and MetS remained positive, whereas a significant negative relationship emerged between ASM and MetS. Lower muscle mass was independently associated with higher cardiovascular risk after controlling for VFA. Clinical interventions to reduce muscle loss in older adulthood may be beneficial for reducing the risk of MetS and improving cardiovascular health.


Assuntos
Composição Corporal/fisiologia , Síndrome Metabólica/fisiopatologia , Músculo Esquelético/metabolismo , Absorciometria de Fóton , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Estudos Transversais , Feminino , Humanos , Gordura Intra-Abdominal/metabolismo , Japão/epidemiologia , Síndrome Metabólica/metabolismo , Músculo Esquelético/patologia , Obesidade Abdominal/complicações , Fatores de Risco , Sarcopenia/complicações
7.
BMJ Open ; 10(8): e039944, 2020 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-32801209

RESUMO

OBJECTIVES: Globalisation has given medical university students the opportunity to pursue international electives in other countries, enhancing the long-term socialisation of medical professionals. This study identified the long-term effects of international electives on the professional identity formation of medical students. DESIGN: This is a qualitative study. SETTING: The authors interviewed Japanese medical professionals who had completed their international electives more than 10 years ago, and analysed and interpreted the data using a social constructivism paradigm. PARTICIPANTS: A total of 23 medical professionals (mean age 36.4 years; range 33-42 years) participated in face-to-face, semistructured in-depth interviews. RESULTS: During the data analysis, 36 themes related to professional identity formation were identified, and the resulting themes had five primary factors (perspective transformation, career design, self-development, diversity of values and leadership). It was concluded that international electives for medical students could promote reflective self-relativisation and contribute to medical professional identity formation. Additionally, such electives can encourage pursuing a specialisation and academic or non-academic work abroad. International electives for medical students could contribute to medical professional identity formation on the basis of cross-cultural understanding. CONCLUSIONS: This study addressed a number of issues regarding the long-term impact of international elective experiences in various countries on the professional identity formation of Japanese medical professionals. This study offers some guidance to mentors conducting international electives and provides useful information for professional identity formation development in medical professionals.


Assuntos
Internacionalidade , Identificação Social , Estudantes de Medicina , Adulto , Feminino , Saúde Global , Humanos , Masculino , Pesquisa Qualitativa
8.
BMJ Open ; 9(7): e027969, 2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31272978

RESUMO

OBJECTIVES: Globalisation has increased the opportunities for health professionals working in developed countries to provide clinical and educational support in developing countries. However, how these experiences contribute to the leadership competency of health professionals is unclear; therefore, this study explored this with the objective of analysing the process of developing individual leadership competency. DESIGN: This is a qualitative descriptive study. Qualitative descriptive study is widely used in healthcare research, particularly to describe the nature of various healthcare phenomena. Qualitative descriptive data were collected in face-to-face, semistructured interviews. SETTING: The authors interviewed Japanese health professionals who participated in an international medical cooperation project as part of a multinational medical team between July 2017 and March 2018, and analysed and interpreted the data using a social constructivism paradigm. PARTICIPANTS: The authors interviewed 20 research participants, including 5 nurses, 5 dentists and 10 physicians with an average of 15.3 years of clinical experience. RESULTS: The interviews identified 58 emergent themes related to their leadership competency, 23 of which affected the actual medical care in their own institutions. The authors categorised the 58 emergent themes into seven competency areas: leadership concepts, teambuilding, direction setting, communication, business skills, working with others and self-development. The authors identified the relationships among each competency and identified differences between professions: nurses particularly reflected on their empathic attitudes towards patient after global clinical health experience; dentists tended to reflect on their business skills; physicians tended to reflect on their leadership concepts and teambuilding. CONCLUSIONS: This study clarified the leadership competency gained through short-term global clinical health experience and the process of individual leadership competency development. The findings provide expected learning competency for those considering medical practice in developing or other countries in the future.


Assuntos
Competência Clínica , Pessoal de Saúde , Cooperação Internacional , Liderança , Adulto , Feminino , Saúde Global , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
9.
Gerontology ; 65(4): 397-406, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31096217

RESUMO

BACKGROUND: Androgen production following exercise has been suggested to contribute anabolic actions of muscle. However, the underlying mechanisms of the androgen receptor (AR) in androgen's action are still unclear. OBJECTIVE: In the present study, we examined androgen/AR-mediated action in exercise, especially for the suppression of myostatin, a potent negative regulator of muscle mass. METHODS: To examine the effects of exercise, we employed low-intensity exercise in mice and electric pulse stimulation (EPS) in C2C12 myotubes. Androgen production by C2C12 myotubes was measured by enzyme-linked immunosorbent assay. To block the action of AR, we pretreated C2C12 myotubes with flutamide. Quantitative real-time polymerase chain reaction was used to determine the expression levels of proteolytic genes including CCAAT/enhancer-binding protein delta (C/EBPδ), myostatin and muscle E3 ubiquitin ligases, as well as myogenic genes such as myogenin and PGC1α. The activation of 5'-adenosine-activated protein kinase and STAT3 was determined by Western blot analysis. RESULTS: Both mRNA and protein levels of AR significantly increased in skeletal muscle of low-intensity exercised mice and C2C12 myotubes exposed to EPS. Production of testosterone and dihydrotestosterone from EPS-treated C2C12 myotubes was markedly increased. Of interest, we found that myostatin was clearly inhibited by EPS, and its inhibition was significantly abrogated when AR was blocked by flutamide. To test how AR suppresses myostatin, we examined the effects of EPS on C/EBPδ because the promoter region of myostatin has several C/EBP recognition sites. C/EBPδ expression was decreased by EPS, and this decrease was negated by flutamide. IL-6 and phospho-STAT3 (pSTAT3) expression, the downstream pathway of myostatin, were decreased by EPS and this was also reversed by flutamide. Similar downregulation of C/EBPδ, myostatin, and IL-6 was seen in skeletal muscle of low-intensity exercised mice. CONCLUSIONS: Muscle AR expression and androgen production were increased by exercise and EPS treatment. As a mechanistical insight, it is suggested that AR inhibited myostatin expression transcriptionally by C/EBPδ suppression, which negatively influences IL-6/pSTAT3 expression and consequently contributes to the prevention of muscle proteolysis during exercise.


Assuntos
Proteína delta de Ligação ao Facilitador CCAAT/genética , Fibras Musculares Esqueléticas/metabolismo , Miostatina/genética , Condicionamento Físico Animal , Receptores Androgênicos/genética , Antagonistas de Androgênios/farmacologia , Animais , Proteína delta de Ligação ao Facilitador CCAAT/efeitos dos fármacos , Di-Hidrotestosterona/metabolismo , Estimulação Elétrica , Flutamida/farmacologia , Técnicas In Vitro , Interleucina-6/metabolismo , Camundongos , Fibras Musculares Esqueléticas/efeitos dos fármacos , Miogenina/efeitos dos fármacos , Miogenina/genética , Miostatina/efeitos dos fármacos , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/efeitos dos fármacos , Coativador 1-alfa do Receptor gama Ativado por Proliferador de Peroxissomo/genética , Reação em Cadeia da Polimerase em Tempo Real , Receptores Androgênicos/metabolismo , Fator de Transcrição STAT3/efeitos dos fármacos , Fator de Transcrição STAT3/metabolismo , Transdução de Sinais , Testosterona/metabolismo , Transcriptoma
10.
BMC Fam Pract ; 19(1): 186, 2018 11 29.
Artigo em Inglês | MEDLINE | ID: mdl-30497398

RESUMO

BACKGROUND: The medical practice of general practitioners/family physicians in urban areas differs from that in rural areas, accounting for the difference in specific competencies. However, variations in competencies in community healthcare required for general practitioners/family physicians in urban areas compared with those in rural areas have not yet been fully clarified. Thus, this study aimed to elucidate the competencies required for general practitioners/family physicians, especially in those characteristic to urban areas, and compare them with those in non-urban/rural areas. METHODS: A qualitative study with individual interviews and qualitative data analysis was conducted. Participants were selected by purposive sampling, and 10 general practitioners/family physicians with clinical experience of ≥7 y after graduation and ≥ 1 y in both urban and non-urban (rural) areas in Japan were recruited. Additionally, semi-structured individual interviews in a private room around the workplace of the interviewee between September 2014 and September 2016 were conducted. For data collection, interview transcripts were analyzed according to the "Steps for Coding and Theorization" method, a sequential and thematic qualitative data analysis technique and data analysis since March 2018. RESULTS: We interviewed 10 general practitioners/family physicians of Japan and extracted 10 themes as competencies characteristic to general practitioners/family physicians in urban areas. In addition to the known competencies on urban underserved care, we newly clarified the competencies of the ability to integrate divided care and ability to coordinate and collaborate with various medical care and welfare professionals in urban areas. CONCLUSION: This study was one of the few studies describing the characteristic competencies of urban general practitioners. In summary, a competency necessary for general practitioners in urban areas is to understand the urban context and provide contextual care suitable for urban areas. In the modern age, where urban population concentration is progressing and the interest in urban health is rising, our study will give certain suggestions for primary care education and practice necessary for urban areas.


Assuntos
Competência Clínica , Serviços de Saúde Comunitária/organização & administração , Clínicos Gerais/normas , Médicos de Família/normas , Pesquisa Qualitativa , População Rural , População Urbana , Adulto , Feminino , Humanos , Japão , Masculino , Atenção Primária à Saúde/normas , Estudos Retrospectivos
11.
BMJ Open ; 8(11): e021759, 2018 11 25.
Artigo em Inglês | MEDLINE | ID: mdl-30478106

RESUMO

INTRODUCTION: Non-valvular atrial fibrillation (NVAF) is known as a robust risk factor for stroke. Recent reports have suggested a risk of dementia with NVAF, but much remains unknown regarding the relationship between this mechanism and the potential protective effects of novel anticoagulants (direct oral anticoagulants (DOACs), or non-vitamin K oral anticoagulants). METHODS AND ANALYSIS: This study, the strategy to obtain warfarin or DOAC's benefit by evaluating registry, is an investigator-initiated, multicentre, prospective, observational, longitudinal cohort study comparing the effects of warfarin therapy and DOACs on cerebrovascular diseases and cognitive impairment over an estimated duration of 36 months. Once a year for 3 years, the activities of daily living and cognitive functioning of non-demented patients with NVAF will be assessed. Demographics, risk factors, laboratory investigations, lifestyle, social background and brain MRI will be assessed. ETHICS AND DISSEMINATION: This protocol has been approved by the ethics committee of the National Center for Geriatrics and Gerontology (No. 1017) and complies with the Declaration of Helsinki. Informed consent will be obtained before study enrolment and only coded data will be stored in a secured database. The results will be published in peer-reviewed journals and presented at scientific meetings to ensure the applicability of the findings in clinical practice. TRIAL REGISTRATION NUMBER: UMIN000025721.


Assuntos
Antitrombinas/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Disfunção Cognitiva/prevenção & controle , Demência/prevenção & controle , Atividades Cotidianas , Administração Oral , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica/métodos , Humanos , Estudos Longitudinais , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Sistema de Registros
13.
PLoS One ; 13(1): e0191318, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29351340

RESUMO

BACKGROUND: Interleukin-6 (IL-6) is an inflammatory cytokine. Whether systemic IL-6 affects atrogene expression and disuse-induced skeletal muscle atrophy is unclear. METHODS: Tail-suspended mice were used as a disuse-induced muscle atrophy model. We administered anti-mouse IL-6 receptor antibody, beta-hydroxy-beta-methylbutyrate (HMB) and vitamin D to the mice and examined the effects on atrogene expression and muscle atrophy. RESULTS: Serum IL-6 levels were elevated in the mice. Inhibition of IL-6 receptor suppressed muscle RING finger 1 (MuRF1) expression and prevented muscle atrophy. HMB and vitamin D inhibited the serum IL-6 surge, downregulated the expression of MuRF1 and atrogin-1 in the soleus muscle, and ameliorated atrophy in the mice. CONCLUSION: Systemic IL-6 affects MuRF1 expression and disuse-induced muscle atrophy.


Assuntos
Regulação da Expressão Gênica/efeitos dos fármacos , Elevação dos Membros Posteriores/efeitos adversos , Interleucina-6/antagonistas & inibidores , Atrofia Muscular/tratamento farmacológico , Atrofia Muscular/genética , Animais , Interleucina-6/sangue , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Atrofia Muscular/sangue , Atrofia Muscular/etiologia , Valeratos/farmacologia , Valeratos/uso terapêutico , Vitamina D/farmacologia , Vitamina D/uso terapêutico
14.
BMC Med Educ ; 18(1): 20, 2018 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-29370796

RESUMO

BACKGROUND: Patient-centered care has been one of the most frequently discussed principles in medical practice. However, there is a serious concern that the patient-centered attitudes of physicians diminish over the course of their medical education. This longitudinal study examined changes in resident physicians' patient-centered attitudes and their confidence in communicating with patients, and explored the relationship between the two traits. METHODS: The study participants were resident physicians at a university hospital in Tokyo. Participants' patient-centered attitudes (as measured by the Patient-Practitioner Orientation Scale [PPOS]), and their confidence in communicating with patients (as per the Physician Confidence in the Medical Interview scale: [PCMI]) were assessed through self-reported questionnaires completed at the beginning of residency (n = 204) and again at the end of the first year (n = 95). RESULTS: PPOS scores declined significantly during the year, both in terms of attitude toward sharing information and decision-making with patients, and attitude of caring for patients' expectations and emotions. The shift in caring attitude differed significantly by gender. The increase in PCMI score was greater for those with a smaller decrease in PPOS score. CONCLUSIONS: As seen in previous studies of medical students, resident physicians' patient-centered attitudes declined during their first year of residency, while there may be a gender-based difference within the shift. The increase in physicians' confidence in communicating with patients was greater for those who showed a smaller decline in patient-centered attitude. Additional studies are needed to detail the changes in physicians' attitudes, confidence, and communication skills over the course of their medical training, and to develop systematic assessment and training programs.


Assuntos
Assistência Centrada no Paciente , Médicos , Estudantes de Medicina , Adulto , Atitude do Pessoal de Saúde , Empatia , Feminino , Humanos , Internato e Residência , Estudos Longitudinais , Masculino , Relações Médico-Paciente , Médicos/psicologia , Estudantes de Medicina/psicologia , Inquéritos e Questionários , Fatores de Tempo , Tóquio , Adulto Jovem
15.
BMC Med Educ ; 17(1): 34, 2017 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-28178986

RESUMO

BACKGROUND: Sharing information is crucial for discussion of problems and treatment decision making by patients and physicians. However, the focus of communication skills training in undergraduate medical education has been on building the relationship and gathering information; thus, resident physicians tend to be less confident about sharing information and planning treatment. This study evaluated the medical interviews conducted by resident physicians with a focus on information giving, and investigated its relationships with their confidence in communication and simulated patient (SP) satisfaction. METHODS: Among 137 junior resident physicians at a university hospital in Japan who participated in a survey of communication skills, 25 volunteered to conduct simulated medical interviews. The medical interviews were video-recorded and analyzed using the Roter Interaction Analysis System, together with additional coding to explore specific features of information giving. The SPs evaluated their satisfaction with the medical interview. RESULTS: Resident physicians who were more confident in their communication skills provided more information to the patients, while SP satisfaction was associated only with patient-prompted information giving. SPs were more satisfied when the physicians explained the rationales for their opinions and recommendations. CONCLUSION: Our findings underscore the importance of providing relevant information in response to the patient requests, and explaining the rationales for the opinions and recommendations. Further investigation is needed to clinically confirm our findings and develop an appropriate communication skills training program.


Assuntos
Educação de Pós-Graduação em Medicina/normas , Disseminação de Informação , Internato e Residência/normas , Corpo Clínico Hospitalar/psicologia , Satisfação do Paciente , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Adulto , Comunicação , Educação de Pós-Graduação em Medicina/métodos , Feminino , Hospitais Universitários , Humanos , Internato e Residência/métodos , Japão , Masculino , Anamnese/métodos , Anamnese/normas , Corpo Clínico Hospitalar/educação , Corpo Clínico Hospitalar/normas , Simulação de Paciente , Assistência Centrada no Paciente/métodos , Autoimagem , Adulto Jovem
16.
Geriatr Gerontol Int ; 16(9): 983-1001, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27594406

RESUMO

AIM: In 2005, the Japan Geriatrics Society published a list of potentially inappropriate medication that was an extract from the "Guidelines for medical treatment and its safety in the elderly 2005." The 2005 guidelines are due for a revision, and a new comprehensive list of potentially inappropriate medications is required. METHODS: A total of 15 diseases, conditions and special areas related to their clinical care were selected. We originated clinical questions and keywords for these 15 areas, carried out a systematic review using these search criteria, and formulated guidelines applying the Grading of Recommendations Assessment, Development and Evaluation system advocated by Minds2014. If we did not find good evidence despite the drug being clinically important, we looked for evidence of efficacy and for disease-specific guidelines, and incorporated them into our guidelines. RESULTS: We selected 2098 articles (140 articles per area), and extracted another 186 articles through a manual search. We further added guidelines based on disease entity and made two lists, one of "drugs to be prescribed with special caution" and the other of "drugs to consider starting," primarily considering individuals aged 75 years or older or those who are frail or in need of special care. CONCLUSIONS: New lists of potentially inappropriate medications and potential prescribing omissions called "Screening Tool for Older Person's Appropriate Prescriptions for Japanese" were constructed. We anticipate that future studies will highlight more evidence regarding the safety of high-quality drugs, further improving the provision of appropriate medical care for the elderly. Geriatr Gerontol Int 2016: 16: 983-1001.


Assuntos
Geriatria/normas , Prescrição Inadequada/estatística & dados numéricos , Segurança do Paciente , Lista de Medicamentos Potencialmente Inapropriados/normas , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Japão , Masculino , Programas de Rastreamento/normas , Sociedades Médicas/normas
17.
PLoS One ; 10(8): e0136597, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26317347

RESUMO

INTRODUCTION: Metabolic syndrome causes insulin resistance and is associated with risk factor clustering, thereby increasing the risk of atherosclerosis. Recently, endothelial nitric oxide synthase deficient (eNOS-/-) mice have been reported to show metabolic disorders. Interestingly, eNOS has also been reported to be expressed in non-endothelial cells including adipocytes, but the functions of eNOS in adipocytes remain unclear. METHODS AND RESULTS: The eNOS expression was induced with adipocyte differentiation and inhibition of eNOS/NO enhanced lipolysis in vitro and in vivo. Furthermore, the administration of a high fat diet (HFD) was able to induce non-alcoholic steatohepatitis (NASH) in eNOS-/- mice but not in wild type mice. A PPARγ antagonist increased eNOS expression in adipocytes and suppressed HFD-induced fatty liver changes. CONCLUSIONS: eNOS-/- mice induce NASH development, and these findings provide new insights into the therapeutic approach for fatty liver disease and related disorders.


Assuntos
Adipócitos/metabolismo , Lipólise , Óxido Nítrico Sintase Tipo III/biossíntese , PPAR gama/metabolismo , Adipócitos/patologia , Animais , Gorduras na Dieta/efeitos adversos , Gorduras na Dieta/farmacologia , Regulação Enzimológica da Expressão Gênica/efeitos dos fármacos , Síndrome Metabólica/genética , Síndrome Metabólica/metabolismo , Síndrome Metabólica/patologia , Camundongos , Camundongos Knockout , Óxido Nítrico Sintase Tipo III/genética , Hepatopatia Gordurosa não Alcoólica/induzido quimicamente , Hepatopatia Gordurosa não Alcoólica/genética , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/patologia , PPAR gama/genética
18.
J Am Med Dir Assoc ; 16(9): 799.e7-799.e12, 2015 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-26170032

RESUMO

OBJECTIVES: Previous studies have suggested the relationship between physical function, mortality, and autonomic nervous activity in frail elderly and that maintaining sympathetic nervous activity might lead to improved physical function and mortality in the elderly population. The aim of this study was to investigate the utility of sympathetic nervous activity measured by heart rate variability in frail elderly patients undergoing inpatient rehabilitation, further focusing the nervous activity on the effect of rehabilitation therapy. DESIGN: Prospective cohort study. PARTICIPANTS: Sixty-one subjects aged 75 years or older were recruited after treatment of acute phase illness. MEASUREMENTS: Before undergoing rehabilitation, data of 24-hour Holter monitoring and a blood venous sample were obtained. From RR intervals in the electrocardiogram, heart rate and SDs of all NN intervals in all 5-minute segments of the entire recording, power spectral density, low frequency (LF), high frequency (HF), and low frequency/high frequency (LF/HF) were calculated. Functional Independence Measure (FIM) and Barthel index were used to measure physical function. RESULTS: FIM score and Barthel index were 46.8 ± 25.4 and 32.8 ± 31.7, respectively. Serum total protein, albumin, hemoglobin, and total cholesterol were all significantly related to FIM score and Barthel index before rehabilitation. Heart rate variability indices did not show a significant relationship with physical function, whereas the high LH/HF group showed significant improvement in physical function compared with the low LH/HF group. Moreover, LF/HF frequency was a predictive factor for improvement of physical function after 2 months of rehabilitation. CONCLUSION: A favorable effect of preserved LF/HF on rehabilitation outcome was observed in elderly undergoing rehabilitation. Preservation of sympathetic nervous activity may lead to improved physical function in the elderly.


Assuntos
Transtornos Cerebrovasculares/fisiopatologia , Transtornos Cerebrovasculares/reabilitação , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/reabilitação , Idoso Fragilizado , Frequência Cardíaca/fisiologia , Sistema Nervoso Simpático/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Eletrocardiografia Ambulatorial , Feminino , Humanos , Japão , Masculino , Estudos Prospectivos , Resultado do Tratamento
19.
Patient Educ Couns ; 96(3): 361-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24912746

RESUMO

OBJECTIVE: This study aimed to explore the relationships among physicians' confidence in conducting medical interviews, their attitudes toward the patient-physician relationship, and undergraduate training in communication skills among resident physicians in Japan. METHODS: Participants were 63 first-year resident physicians at a university hospital in Tokyo. The Physician Confidence in the Medical Interview scale (PCMI) was constructed based on the framework of the Calgary-Cambridge Guide. Additionally, participants' attitudes toward the patient-physician relationship (Patient-Practitioner Orientation Scale; PPOS), undergraduate experience of communication skills training, and demographic characteristics were assessed through a self-reported questionnaire. RESULTS: The internal consistency of the PCMI and PPOS scales were adequate. As expected from the undergraduate curriculum for medical interviews in Japan, residents had relatively higher confidence in their communication skills with respect to gathering information and building the relationship, whereas less confident about sharing information and planning treatment. The PCMI was associated with a more patient-centered attitude as measured by the PPOS. CONCLUSION: These scales could be useful tools to measure physicians' confidence and attitudes in communicating with patients and to explore their changes through medical education. PRACTICE IMPLICATIONS: Residency programs should consider including systematic training and assessment in communication skills related to sharing information and planning treatment.


Assuntos
Comunicação , Internato e Residência , Relações Médico-Paciente , Atitude do Pessoal de Saúde , Currículo , Educação Médica , Feminino , Hospitais Universitários , Humanos , Japão , Masculino , Médicos , Projetos Piloto , Autoimagem , Inquéritos e Questionários
20.
Geriatr Gerontol Int ; 14(1): 159-66, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23879364

RESUMO

AIM: To investigate the relationship between physical function, mortality and autonomic nervous activity measured by heart rate variability of elderly in long-term care. METHODS: Cross-sectional and longitudinal studies were carried out at hospitals and health service facilities for the elderly in Nagano prefecture, Japan, from July 2007 to March 2011. A total of 105 long-term care older adults and 17 control older adults with independent physical function were included. The Functional Independence Measure (FIM) and Barthel Index were determined as indices of physical function. Twenty-four-hour Holter monitoring was carried out. From RR intervals in electrocardiograms, heart rate and standard deviations of all NN intervals in all 5-min segments of the entire recording, power spectral density, low frequency, high frequency and low frequency/high frequency (LF/HF) were calculated. RESULTS: FIM score and Barthel Index were 46 ± 26 and 30 ± 31, respectively, in long-term care elderly. FIM and Barthel index were significantly correlated with heart rate and the standard deviations of all NN intervals after adjustment for age, sex, cardiovascular risk factors and FIM. Furthermore, LF/HF was significantly decreased in long-term care elderly compared with control elderly after adjustment for covariates. In addition, decrease in LF/HF was an independent risk factor for mortality. CONCLUSION: Low LF/HF activity was observed in long-term care elderly and was related to an increase of overall mortality.


Assuntos
Envelhecimento , Ansiedade/mortalidade , Sistema Nervoso Autônomo/fisiopatologia , Eletrocardiografia , Frequência Cardíaca/fisiologia , Assistência de Longa Duração , Idoso , Idoso de 80 Anos ou mais , Ansiedade/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
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