Medical School Staff's Standardized Patient Experience Alters their Understanding of Student Education.

Since knowledge of medical communication education and objective structured clinical examination (OSCE) is increasing, a greater number of simulated patients/standardized patients (SPs) will undoubtedly be needed throughout Japan. At Tokyo Medical University in Japan, non-medical professional school staff members have acted as SPs in post-clinical clerkship OSCEs. However, except for academic or medical staff, no other staff members were reported to have acted as SPs. Therefore, the significance of the large numbers of solely medical school staff acting as SPs needs to be investigated. The purpose of this study was to determine how acting as SPs affects medical school staff's understanding of student education and whether it is useful for university staff to know what kind of education is being provided at their own school. A mixed-method study was utilized to investigate what kind of attitudinal changes occurred among medical school staff after their SP experiences. Accordingly, the researchers conducted a questionnaire survey with staff members after they acted as SPs. The questionnaire was developed through semi-structured interviews. The majority of the participants' responses were positive. They claimed that they had gained knowledge on the testing of students and now understood the importance of doctors' communication skills. Furthermore, many stated that all staff members at medical schools should experience acting as SPs. Medical school staff understands students' education processes better after acting as SPs. Japan's SPs are aging and becoming fewer; however, these SP numbers could be supplemented by medical school staff members.

Effects of rikkunshito on quality of life in patients with gastroesophageal reflux disease refractory to proton pump inhibitor therapy.

We investigated the effects of rikkunshito, in combination with a proton pump inhibitor, on symptoms and quality of life in patients with proton pump inhibitor-refractory gastroesophageal reflux disease. The subjects were 47 patients with gastroesophageal reflux disease with residual symptoms such as heartburn following 8 weeks of proton pump inhibitor therapy. We administered these subjects rikkunshito in combination with a proton pump inhibitor for 6-8 weeks. We scored their symptoms of heartburn, fullness, abdominal discomfort, and abdominal pain, and surveyed their quality of life using the Reflux Esophagitis Symptom Questionnaire, comprising questions concerning daily activities, meals (changes in amount and favorite foods), and sleep (getting to sleep and early morning waking). Improvement was seen in all symptoms, and quality of life scores for meals and sleep also improved. These results indicate that combination therapy with rikkunshito and a proton pump inhibitor improves quality of life related to eating and sleep in patients with patients with proton pump inhibitor-refractory gastroesophageal reflux disease.

How do case presentation teaching methods affect learning outcomes?--SNAPPS and the One-Minute preceptor.

BACKGROUND: Various techniques have been developed to enable preceptors to teach residents effectively in outpatient settings to promote active learning, including SNAPPS and the One-Minute Preceptor (OMP). This study aimed to ascertain the differences between SNAPPS and the OMP in case presentation content and learner evaluation when used to teach residents about case presentation. METHODS: From 2011 to 2013, participants were 71 junior clinical residents employed in two hospitals for clinical training. They were randomly allocated to two groups, one using SNAPPS and the other the OMP. From recorded discussions, the "differential diagnoses", "questions and uncertainties", "treatment plans", and "learning issues" were counted. Also, a self-evaluation form was distributed at the end of the study to evaluate the residents' satisfaction with the case presentation. RESULTS: Members of the SNAPPS group used significantly more meaning units related to questions and uncertainties compared with those of the OMP group (P < 0.001). Self-evaluation sheets revealed that members of the SNAPPS group had significantly higher positive responses than those of the OMP group in terms of the following evaluations: "It was easy to bring up questions and uncertainties" (P = 0.046), "It was easy to present the case efficiently" (P = 0.002), "It was easy to present the case in the sequence given" (P = 0.029), and "I was able to give an in-depth case presentation" (P = 0.005). CONCLUSIONS: SNAPPS may induce more meaning units related to questions and uncertainties and give more satisfaction to residents than the OMP.

Prevalence of Helicobacter pylori infection with healthy subjects in Japan.

BACKGROUND AND AIM: Only few large-scale epidemiological studies have examined the prevalence of Helicobacter pylori (H. pylori) infection in Japan. The aim of the present study was to estimate the prevalence and incidence of H. pylori infection in Japan in terms of gender, age and region. METHODS: Serum anti-H. pylori antibody testing was included in workers' annual health checks conducted by T-company's health insurance association in 2008. The testing was continued for the next 5 years in 35-year-old subjects. RESULTS: The total number of subjects was 21 144 (18 398 males and 2746 females). Stratified for age, there were 5016 subjects (male:female=4219:797) in their 30s, 8748 (7770:978) in their 40s, 5589 (4807:782) in their 50s, and 1769 (1584:185) in their 60s. The H. pylori seropositive rate (male:female) was 27.5% (27.5:27.7) overall, 18.0% (18.3:16.1) in subjects in their 30s, 22.9% (22.7:24.7) in those in their 40s, 37.4% (37.2:38.2) in those in their 50s, and 46.1% (45.7:49.2) in those in their 60s. The prevalence of H. pylori seropositivity increased as age increased; however, no significant differences were seen between genders or among regions (χ2 test). The numbers of 35-year-old subjects from 2008 to 2012 were 1072, 1107, 941, 1065, and 940, respectively. The corresponding H. pylori seropositive rates were 17.4, 17.4, 14.3, 13.3, and 14.0%, respectively. CONCLUSION: The Japanese H. pylori infection rate had already declined to 27.5% in 2008, with subjects in the 35-70 age range. The prevalence of H. pylori infection is also decreasing gradually from 2008 to 2012.

Changes in prevalence of Helicobacter pylori in Japan from 2008 to 2018: a repeated cross-sectional study.

OBJECTIVES: To understand the recent prevalence and time trends of Helicobacter pylori infection rates in the Japanese population. DESIGN: Repeated cross-sectional study. PARTICIPANTS: A total of 22 120 workers (age: 35-65 years) from one Japanese company, who underwent serum H. pylori antibody tests in a health check-up between 2008 and 2018. MEASURES: H. pylori infection rates among participants aged 35 years from 2008 to 2018, and participants aged 35, 40, 45, and 50-65 years in 2018, based on the results of serum antibody tests, were analysed. In the 2018 analysis, in addition to the antibody test results, all participants who had undergone eradication treatment for H. pylori were considered as infected. Trends were examined using joinpoint analysis. RESULTS: H. pylori was detected in 1100 of 7586 male and 190 of 1739 female participants aged 35 years. Annual infection rates among those aged 35 years showed linear downward trends as follows: men, 17.5% in 2008 to 10.1% in 2018 (slope: -0.66); women, 12.3% in 2008 to 9.2% in 2018 (slope: -0.51) without joinpoints. In the 2018 analysis, 2432 of 9580 men and 431 of 1854 women were H. pylori positive. Infection rates tended to increase with older age (men: 11.0% (35 years) to 47.7% (65 years); women: 10.0% (35 years) to 40.0% (65 years)), and showed joinpoints in both sexes (men: 54 years; women: 45 years). Although both the first and second trends were upward, the second trend for both men and women was steeper than the first trend (p<0.05). CONCLUSIONS: Our study demonstrated that in the previous 11 years, infection rates of H. pylori in 35-year-old male and female Japanese workers have constantly decreased, and furthermore, analysis of various age groups showed joinpoints around 50 years, suggesting a consistent declining trend in H. pylori infection rates in Japan.

An Elderly Woman With Gibbus Deformity and Physiologic Shock.

Physiological shock requires prompt diagnosis and treatment in the emergency department. We present a case of physiological shock in a 91-year-old woman resulting from obstruction of the left atrium and inferior vena cava by a giant esophageal hiatal hernia, identified using computed tomography imaging. The patient's age and history, including diet and eating behavior (namely needing to lie down immediately after a meal), and kyphotic posture were important factors to consider in establishing the differential diagnosis. While rare, a giant esophageal hiatal hernia should be considered in the differential diagnosis of obstructive shock.

Assessing the empathy of medical students during medical interview training in Japan by using mixed-methods surveys of simulated patients.

This article was migrated. The article was marked as recommended. Background: Medical interviews are performed during objective structured clinical examinations, to assess the communication skills of medical students. In particular, medical students are assessed regarding whether they demonstrate empathy during these staged interviews. However, no studies to date have analyzed the validity of the methods to evaluate empathy during objective structured clinical examinations. Aim: Here we sought to identify factors affecting whether simulated (standardized) patients (SPs) felt that the medical students had treated them empathetically during medical interview training. Methods: The training involved the participation of SPs during the bedside learning of fifth-year medical students in Japan. After the students completed medical interview training, we conducted a questionnaire-based survey. We developed the list of questionnaire items through semi-structured interviews asking SPs to describe when the student had been empathetic. Results: The item "I felt that the student was empathic throughout the interview" was significantly correlated with "I was given enough time to talk at the beginning of the interview," "The student made good eye contact," "The student's attitude was appropriate," "I was able to say enough of what I wanted to talk about," and "The student used phrases that expressed empathy." Multiple regression analysis revealed that "The student used phrases that expressed empathy" was the only independent predictor of "I felt that the student was empathic throughout the interview." Conclusions: The factor that correlated most strongly with the SP feeling that the student was empathic during a medical interview was "The student used phrases that expressed empathy." However, correlations also occurred with open-ended questions and the student's level of attention at the beginning of the interview and with the student's attitude. Together, these findings indicate that several types of both verbal and nonverbal communication determined whether SPs felt that medical students showed empathy during staged medical interviews.

Plasma B-type natriuretic peptide level is associated with left ventricular hypertrophy among obstructive sleep apnoea patients.

OBJECTIVES: To examine whether increased plasma levels of B-type natriuretic peptide (BNP) are associated with cardiac structural and functional abnormalities in obstructive sleep apnoea (OSA) patients, taking into consideration the confounding effect of obesity. MEASUREMENTS: In a cross-sectional study, polysomnography, echocardiography and the measurement of the serum levels of BNP were performed in 235 consecutive subjects (age 52 +/- 14 years) visiting our sleep clinic. Left ventricular hypertrophy (LVH) [left ventricular mass index (LVMI) > or = 125 g/m in men, and > or = 110 g/m in women] and cardiac diastolic function (E/A ratio) were determined by echocardiography. RESULTS: The LVMI, prevalence rate of LVH and body mass index (BMI) were higher, and the E/A ratio lower in the subjects with severe OSA (apnoea-hypopnoea index > or = 30/h, n = 146, LVH 80%) than in those with mild to moderate OSA (n = 89, LVH 35%; P < 0.01), although plasma BNP levels were similar in the two groups. Although the log-transformed plasma BNP level showed a negative correlation with BMI, the results of binary logistic regression analysis demonstrated that the quintile value of BNP was an independent significant variable for the identification of LVH (adjusted odds ratio in quintile 5 = 4.01, 95% confidence interval 1.18-13.70, P < 0.01), even after adjusting for obesity and other risk factors. CONCLUSION: An increased likelihood of cardiac structural and functional abnormalities was observed with increasing severity of OSA. Increased plasma levels of BNP do seem to reflect an increased likelihood of LVH in patients with severe OSA.

Gastric Arteriovenous Malformation with Characteristic Endoscopic Findings.

Gastric arteriovenous malformation (AVM) is an uncommon cause of upper gastrointestinal bleeding, and the endoscopic findings are unclear. We herein describe a case of gastric AVM in a 28-year-old man. Esophagogastroduodenoscopy showed a Dieulafoy lesion surrounded by a red mucosa with a sharp margin, which implied blood vessel malformation. Computed tomography angiography and conventional angiography revealed aggregated vessels on the greater curvature. Partial gastrectomy was performed, with no recurrent bleeding postoperatively. The histopathological diagnosis was AVM. We conclude that gastric AVM should be considered in the differential diagnosis of patients who present with a Dieulafoy lesion surrounded by a red mucosa.

The First Case Report of Cerebral Cyst Infection Due to Helicobacter cinaedi.

We report the first case of cerebral cyst infection by Helicobacter cinaedi, a fastidious spiral-shaped gram-negative rod bacterium. A 70-year-old man visited Tokyo Medical University Hospital with persisting fever since 2 weeks. He underwent surgery and radiotherapy for parapharyngeal space squamous cell carcinoma 10 years ago. The radiotherapy resulted in a cerebral cyst as a side effect, and an Ommaya reservoir was inserted into the cyst. Blood culture and analysis of the brain cyst fluid revealed the presence of spiral-shaped gram-negative rod bacteria, which were identified as H. cinaedi by polymerase chain reaction. Initially, we administered clarithromycin (400 mg per day). After H. cinaedi infection was confirmed, the treatment was changed to meropenem (MEPM 6 g per day). The patient was treated for 43 days in the hospital with intravenous meropenem, and his clinical course was satisfactory. On the 44th day, he was discharged and prescribed oral minocycline (MINO 200 mg per day). After discharge, the patient's H. cinaedi infection did not recur. Our case illustrated the wide clinical spectrum of H. cinaedi as well as the effectiveness of antibiotic therapy comprising MERM and MINO for treating central nervous system infection by this organism.

Concurrent presence of metabolic syndrome in obstructive sleep apnea syndrome exacerbates the cardiovascular risk: a sleep clinic cohort study.

This cross-sectional study was conducted to examine whether the obstructive sleep apnea syndrome (OSAS) is associated with elevation of the pulse wave velocity (PWV) and increase in the plasma levels of C-reactive protein (CRP), both of which are known markers of cardiovascular risk, and also to determine if the concurrent presence of the metabolic syndrome might exacerbate this elevation in the levels of these cardiovascular risk markers in subjects with OSAS. With these objectives, the PWV and serum CRP were measured in 184 subjects attending a sleep clinic. It was found that the PWV and CRP were higher in the subjects with OSAS (n=94) than in those without OSAS (n=90). Furthermore, among the subjects with OSAS, the PWV and CRP were higher in those with the concurrent presence of the metabolic syndrome (n= 41; PWV=1,562+/-19 cm/s; CRP=1.8+/-0.2 mg/l) than in those without metabolic syndrome (n=53; PWV=1,432+/-21 cm/s; CRP=1.2+/-0.1 mg/l) (p<0.05). A general linear model analysis demonstrated that OSAS and metabolic syndrome were independently associated with elevated PWV and increase of the plasma levels of CRP. OSAS appears to be associated with increased cardiovascular risk, as reflected by both elevated PWV and increase of the plasma CRP. The concurrent presence of metabolic syndrome may exacerbate this increase in cardiovascular risk in subjects with OSAS. Therefore, the concurrent presence of metabolic syndrome may constitute an additive cardiovascular risk factor in subjects with OSAS.

The effects of changes in the metabolic syndrome detection status on arterial stiffening: a prospective study.

We conducted a prospective study to examine the effects of alterations of the metabolic syndrome detection status on the rate of progression of arterial stiffness, which is recognized as a marker of arterial damage and an indicator of cardiovascular risk. Brachial-ankle pulse wave velocity as an index of arterial stiffening was recorded twice over a 3-year period in 2080 Japanese men (age, 42 +/- 9 years). At the start of the prospective study, pulse wave velocity was higher in the subjects with metabolic syndrome (n=125) than in those without metabolic syndrome (n=1,955) even after adjusting for mean blood pressure. The annual rate of increase of the pulse wave velocity was higher in the group with persistent metabolic syndrome (27 +/- 51 cm/s/year, n=71) than in the group with regression of metabolic syndrome (6 +/- 39 cm/s/year, n=54) or the group in which metabolic syndrome was absent (13 +/- 37 cm/s/year, n=1843; p < 0.05) after adjustment for changes in blood pressure. In conclusion, the changes in the metabolic syndrome detection status of the subjects during the study period affected the annual rate of progression of arterial stiffening, and persistent metabolic syndrome during the study period was associated with acceleration of arterial stiffening in middle-aged Japanese men. On the other hand, resolution of metabolic syndrome may be associated with attenuation of the progression of arterial damage. Therefore, the increased cardiovascular risk associated with the presence of metabolic syndrome may be at least partly mediated by acceleration of the progression of arterial stiffening.

Acute Adrenal Insufficiency Associated with Rathke's Cleft Cyst.

Rathke's cleft cysts are known to cause hormone-related abnormalities. However, the natural history of this disorder is obscure, so it is rarely associated with acute adrenal insufficiency. We herein describe a case of Rathke's cleft cyst associated with acute adrenal insufficiency in a 27-year-old man. The patient experienced severe headaches due to acute adrenal insufficiency without changes in the size of the cyst. Glucocorticoid administration improved these symptoms, and the cyst spontaneously shrank before operation. This case led us to conclude that Rathke's cleft cysts should be considered in the differential diagnosis of patients who present with adrenal insufficiency, and that the cysts can be reduced by glucocorticoids.

Evaluation of the rapid influenza detection tests GOLD SIGN FLU and Quick Navi-Flu for the detection of influenza A and B virus antigens in adults during the influenza season.

As the characteristics and accuracy of rapid influenza detection tests (RIDTs) vary, the development of a high-performance RIDT has been eagerly anticipated. In this study, the new RIDT GOLD SIGN FLU and the existing RIDT Quick Navi-Flu were evaluated in terms of detecting the antigens of influenza viruses A and B in Japanese adults with influenza-like symptoms. The study was performed from December 2013 to March 2014. Among the 123 patients from whom nasopharyngeal swab specimens were collected, 59 tested positive by viral isolation as the gold standard method (influenza A, n=38; influenza B, n=21). For GOLD SIGN FLU, the sensitivities were 73.7% and 81.0%, and the specificities were 97.6% and 98.0% for influenza A and B, respectively. For Quick Navi-Flu, the sensitivities were 86.8% and 85.7%, and the specificities were 98.8% and 100% for influenza A and B, respectively. The time to the appearance of the line on the test strip was less than 3min for influenza A and less than 2min for influenza B with both RIDTs in more than 90% of cases. GOLD SIGN FLU was useful for diagnosing influenza A, and the result was readily available for influenza B particularly among adult patients. Quick Navi-Flu showed better sensitivities and specificities than GOLD SIGN FLU.

Prognosis-related factors concerning oral and general conditions for homebound older adults in Japan.

PURPOSE: The present study examined the relationship between oral function, such as eating/swallowing, and life prognosis among a homebound elderly population, considering physical and mental function. METHODS: The participants were 511 homebound older adults aged 65 years or older living in four Japanese prefectures. Sex, age, activities of daily living (ADL), cognitive function, underlying disease, nutritional status as Mini-Nutritional Assessment-Short Form (MNA(®)-SF), swallowing function, dietary modification and occlusal status were examined at baseline. Participants were categorized into poor outcome (died or admitted to hospital or nursing home) and good outcome (still under home care) groups at 1-year follow up, and significant related baseline factors were analyzed. In addition, these groups were compared by the ADL subgroup divided into <60 (lower) and ≥60 (higher) by Barthel Index. RESULTS: In total, 473 participants were followed up (poor outcome group 177 [37.4%], good outcome group 296 [62.6%]). Sex, age, ADL, MNA(®)-SF, swallowing function, dietary modification and occlusal support were significantly different between these groups. Logistic regression analysis showed that sex and MNA(®)-SF score were significantly related to prognosis in the lower ADL group, and sex, age, Charlson Comorbidity Index and occlusal support were significantly related in the higher ADL group. CONCLUSIONS: ADL was strongly correlated with life prognosis in homebound older adults. Within the higher ADL participants, occlusal support was related to this outcome.

The relationship between high-sensitive C-reactive protein and pulse wave velocity in healthy Japanese men.

Although pulse wave velocity (PWV) and high-sensitive C-reactive protein (hsCRP) are known as predictors of future cardiovascular events, their association has not been examined. The present study was conducted to evaluate their association in the general population. In 2668 Japanese men (43 +/- 10 years old), PWV was obtained by volume rendering methods, and hsCRP was determined by the latex aggregation method. PWV showed a significant correlation with logarithm of hsCRP (r = 0.06, P < 0.01). The concentration of hsCRP in the highest quartile of PWV was higher than that in the other three groups (P < 0.01). However, multiple linear regression analyses demonstrated that logarithm of hsCRP was not significantly related to PWV, independent from conventional risk factors. Calculated Framingham risk score (FRS) was higher in the highest quartiles of both hsCRP and PWV than in the other groups (P < 0.05). Thus, while increased hsCRP related to increased PWV, they may be independent predictors of atherosclerotic cardiovascular risk. A prospective study to confirm the independency of their significance in predicting future cardiovascular events and to evaluate the usefulness of the combination of both parameters to screen subjects for cardiovascular risk is necessary.

Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure.

While arterial stiffness is known to be related to atherosclerosis, the association between arterial stiffness and cardiac systolic and diastolic function in hypertension has not been fully evaluated. The present study was conducted to simultaneously evaluate the relationship of brachial-ankle pulse wave velocity (PWV) to parameters reflecting atherosclerosis and to those reflecting the risk of congestive heart failure in patients with hypertension. In 147 patients with hypertension, the left ventricular ejection fraction, the ratio of the peak velocity of early rapid filling and the peak velocity of atrial filling (E/A ratio), and left ventricular mass index were obtained from echocardiographs, the intima-media thickness of the common carotid artery was obtained by ultrasonography, the plasma B-type natriuretic peptide (BNP) level was measured by radioimmunoassay, and the brachial-ankle PWV was measured by the volume rendering method. Brachial-ankle PWV correlated positively with the intima-media thickness of the carotid artery, E/A ratio and BNP. Multiple linear regression analysis demonstrated that the relationship between the brachial-ankle PWV and the E/A ratio was significantly independent from other clinical variables. The receiver operator characteristic curve demonstrated that a brachial-ankle PWV of 1,600 cm/s was useful to discriminate mild cardiac diastolic dysfunction (E/A ratio of < or =0.75) (sensitivity=78% and specificity=58%). The present study demonstrated that increased brachial-ankle PWV relates not only to the parameters reflecting atherosclerosis but also to those reflecting cardiac diastolic dysfunction. Therefore, increased arterial stiffness is a possible simultaneous risk for atherosclerotic cardiovascular disease and diastolic heart failure in patients with hypertension.